^rA^T«H'lSt|'i.SS 


HX64152170 
RC887  .G91  1887     A  practical  treatise 


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A   PRACTICAL  TREATISE 


IMPOTENCE,  STERILITY 


ALLIED   DISORDERS 


MALE  SEXUAL  ORGANS, 


BY 

SAMUEL  W.  GROSS,  A.M.,  M.D.,  LL.D., 

PROFESSOR   OF  THE   PRINCIPLES   OF  SURGERY  AND   CLINICAL  SURGERY  IN  THE  JEFFERSON    MEDICAL 

COLLEGE   OF   PHILADELPHIA;     FORMERLY   PRESIDENT  OF   THE   PATHOLOGICAL   SOCIETY   OF 

PHILADELPHIA;     AUTHOR    OF   A    PRACTICAL    TREATISE    ON    TUMORS    OF    THE 

MAMMARY   GLAND  ;    FELLOW  OF   AND   FORMERLY   MUTTER   LECTURER 

ON  SURGICAL  PATHOLOGY  IN  THE   COLLEGE  OF  PHYSICIANS 

OF   PHILADELPHIA;     FELLOW   OF  THE  AMERICAN 

SURGICAL  ASSOCIATION,    ETC.    ETC. 


THIRD  EDITION,  THOROUGHLY  REVISED. 

WITH     SIXTEEN     ILLUSTRATIONS. 


PHILADELPHIA: 


LEA    BROTHERS    &     CO. 

1887. 


Entered  according  to  Act  of  Congress,  in  the  year  18S7,  by 

LEA  BROTHERS   &   CO., 
in  the  Office  of  the  Librarian  of  Congress,  at  Washington. 


DORNAN,    PRINTER. 


PREFACE 


The  rapid  exhaustion  of  two  large  editions  of  this  work,  the  favorable 
comments  which  it  has  received  from  the  periodical  press,  its  translation 
into  the  Russian  language,  and  the  fact  that  it  has  been  out  of  print  for 
several  months,  constitute  valid  evidence  that  it  has  filled  the  void  for  which 
it  was  originally  designed. 

As  was  stated  in  the  first  edition,  of  the  affections  discussed  in  this  brochure 
at  least  two — Impotence  and  Spermatorrhoea — are  commonly  described  as 
functional  diseases  of  the  testicles  ;  while,  according  to  my  observations, 
they  usually  depend  upon  reflex  disturbances  of  the  genitospinal  centre, 
and  are  almost  invariably  induced  or  maintained  by  appreciable  lesions  of 
the  prostatic  portion  of  the  uretura,  which,  as  they  may  not  be  perceived 
by  the  patient,  are  frequently  overlooked  by  the  physician.  A  more  ex- 
tended knowledge  of  these  pathological  facts,  it  is  hoped,  will  afford  a  more 
rational  and  simple  basis  for  treatment. 

My  aim  has  been  to  supply  in  a  compact  form  practical  and  strictly 
scientific  information,  especially  adapted  to  the  wants  of  the  general  prac- 
titioner, in  regard  to  a  class  of  common  and  grave  disorders,  upon  the 
correction  of  which  so  much  of  human  happiness  depends.  In  the  chapter 
on  Sterility,  the  abnormal  conditions  of  the  semen  and  the  causes  which  deprive 
it  of  its  fecundating  properties  are  fully  considered — a  portion  of  the  work 
intended  to  supplement  the  subject  of  sterility  in  the  female.  From  answers 
to  letters  addressed  to  many  of  the  most  prominent  writers  in  this  country 
on  gynecology,  I  find  that,  with  few  exceptions,  the  woman  alone  com- 
mands attention  in  unfruitful  marriages.  The  importance  of  examining  the 
husband  before  subjecting  the  wife  to  operation  will  be  best  appreciated 
when  I  state  that  he  is,  as  a  rule,  at  fault  in  at  least  one  instance  in 
every  six. 


S.  W.  GROSS. 


Philadelphia, 
III2  Walnut  Street,  April,  1887. 


CONTENTS, 


CHAPTER    I. 


IMPOTENCE. 


Sect.  I. — General  observations — Mechanism  of  erection — Classi- 
fication        .       ■  .         .         .  .  .  .  .  ,        17-20 

Sect.  II. — Atonic  impotence. 

A.  Atonic  impotence  from  hypersesthesia  and  inflammation 
of  the  prostatic  urethra — Etiology — Local  effects  of 
masturbation — Masturbation  a  cause  of  stricture  of  the 
urethra — General  effects  of  masturbation — Classification 
— Clinical  history — Neurasthenia — Diagnosis — Prognosis 

— Local  treatment — General  treatment  .  .         .  ,        20-56 

B.  Atonic  impotence  without  hyperaesthesia  of  the  pros- 
tatic urethra — Etiology — Treatment       ....       56-57 

Sect.  III. — Psychical  impotence. 

Etiology — Prognosis — Treatment      .....       57-63 

Sect.  IV. — Symptomatic  impotence. 

From  the  prolonged  use  of  cerebral  sedatives  and  cerebral 
excitants — From  injuries  of  the  brain  and  spinal  cord — 
Prognosis — Treatment  ......       63-66 

Sect.   V. — Organic  impotence. 

A,  Impotence  from  abnormal  conditions  of  the  penis — 
From  malformations  of  the  penis — From  variations  in 
the  size  of  the  penis — From  adhesion  of  the  penis  to  the 


CONTENTS. 

PAGE 

scrotum — From  distortion  of  the  penis — From  induration 
of  the  corpora  cavernosa — From  gummata  of  the  corpora 
cavernosa — From  calcification  of  the  septum  pectiniforme, 
or  corpora  cavernosa — From  retention  of  a  ball  in  the 
corpus  cavernosum — From  shortness  of  the  frenum — 
From  varix  of  the  dorsal  vein  of  the  penis     .  .  .       66-74 

B.  Impotence  from  defects  and  disease  of  the  testes — From 
anorchidism — From  crytorchidism — From  loss  of  the 
testes— From  progressive  atrophy  of  the  testes — From 
syphilitic  orchitis — From  tumors  and  tubercle         .  .        74-76 


CHAPTER    II. 

STERILITY. 

Sect.   I. — General  observations. 

Composition  of  the  semen — Functions  of  the  prostatic  fluid 
— Spermatozoa  —  Spermatic  crystals  —  Classification — 
Relative  frequency  in  the  two  sexes        ....        77-84 

Sect.  II. — Azoospermism. 

From  bilateral  anorchidism — From  congenital  bilateral 
deficiency  of  the  epididymis  and  vas  deferens — From 
failure  of  the  testes  to  descend  into  the  scrotum — From 
affections  of  the  testes — From  bilateral  atrophy  of  the 
testes — From  parenchymatous  orchitis  and  total  disor- 
ganization of  the  substance  of  the  testes — From  syphilitic 
orchitis — From  bilateral  obliteration  of  the  epididymis 
and  vas  deferens — From  abnormal  conditions  of  the 
semen — Sexual  excesses  a  cause  of  infertile  semen — 
Neurasthenia  a  cause  of  infertile  semen — General  diseases 
a  cause  of  infertile  semen — Abnormal  density  of  the 
semen  a  cause  of  sterility — Purulent  semen  a  cause  of 
sterility — Bloody  semen  a  cause  of  sterility — Diagnosis 
— Watery  semen — Colloid  semen  —  Catarrhal  semen — 
Prognosis — Treatment  .......     84-109 


CONTENTS.  VU 

PAGE 

Sect.  III. — Aspermatism. 

A.  Organic  aspermatism — From  seminal  fistulse — From 
congenital  occlusion,  and  deviation  of  the  ejaculatory 
ducts — From  stricture  of  the  ejaculatory  ducts,  and  devia- 
tion of  their  orifices — From  obstruction  of  the  ejacula- 
tory canals  by  sympexions — From  stricture  of  the  urethra 

— From  phimosis  ........    109-119 

B.  Atonic  aspermatism — Etiology  .         .  .         .  .  119 

C.  Anaesthetic  aspermatism — Etiology     .  .  .  .  121 

D.  Psychical  aspermatism  —  Etiology  —  Diagnosis  of 
aspermatism — Prognosis — Treatment      .  .  .  .  123 

Sect.   IA^. — Misemission. 

From  vices  of  conformation   of   the  urethra — From   mal- 
position of  the  meatus — Treatment     .  .  .  .  128 


CHAPTER   III.  .    . 

SPERMATORRHCEA. 

Classification — Nocturnal  pollutions — Diurnal  pollutions — 
Spermorrhagia — Clinical  history — Etiology — Anatomical 
characters — Diagnosis — Prognosis — Treatment        .  .  130 


CHAPTER   IV. 

PROSTATORRHCEA. 

Etiology — Clinical  history — Prostatic  crystals — Pathological 

characters — Diagnosis — Prognosis — Treatment        .  .  160 


LIST  OF  ILLUSTRATIONS. 


FIG. 

PAGE 

I. 

Exploratory  bulbous 

bougie  . 

37 

2. 

Conical  steel  bougie 

42 

3- 

Urethral  dilator     . 

. 

42 

4- 

Urethrotome 

. 

42 

5- 

Syringe  and  perforated  bulbous  explorer 

.45 

6. 

Bulbous  nozzle 

. 

. 

46 

7- 

Catheter-syringe    . 

. 

46 

8. 

Porte-caustique 

47 

9- 

Cupped  conical  steel  bougie  .          . 

47 

lO. 

Porte- remede 

47 

II. 

Psychrophor 

54 

12. 

Spermatozoa 

. 

80 

13- 

Spermatic  crystals 

From  Ultzmann 

80 

14. 

Watery  semen 

.  Ibid. 

104 

15- 

Colloid  semen 

.  Ibid. 

105 

16. 

Prostatic  crystals  . 

162 

IMPOTENCE,  STERILITY,  AND  ALLIED  DISORDERS 
OF  THE  MALE  SEXUAL  ORGANS. 


CHAPTER   I. 

IMPOTENCE. 

Sect.  I.  General  Observations. 

Impotence,  or  inability  to  copulate  or  perform  the  sexual 
act,  is  one  of  the  most  common  of  the  derangements  of  the 
generative  functions,  and  is  due  either  to  deficiency  or 
absence  of  erection,  or  to  congenital  or  acquired  abnormal 
conditions  of  the  genital  organs,  which  render  intromission 
of  the  penis  impracticable.  Hence,  men  who  are  impotent 
are  usually  sterile,  the  power  of  procreating  children  being 
dependent  upon  that  of  having  connection ;  but  as  sterility, 
in  the  strict  acceptation  of  the  term,  implies  nonejaculation, 
or  emission  of  infertile  semen,  it  will  be  discussed  in  a  sepa- 
rate chapter. 

For  a  clear  comprehension  of  the  pathology  of  the  most 
frequent  forms  of  impotence,  a  knowledge  of  the  mechan- 
ism of  normal  erection  and  of  the  nervous  centres  which 
preside  over  it  is  essential. 

Erection  consists  in  augmentation  of  the  volume,  in  stiff- 
ness, and  in  rigidity  of  the  penis,  and  is  due  to  an  increased 

2 


18  IMPOTENCE. 

flow  of  blood  into  that  organ,  as  has  been  experimentally 
demonstrated  by  Eckhard.'  Loven,-  who  extended  the 
investigations  of  Eckhard,  was,  however,  the  first  to  show, 
in  opposition  to  former  theories,  that  the  essential  factor  in 
the  phenomenon  is  active  dilatation  of  the  arterioles  of  the 
cavernous  and  spongy  bodies,  and  not  merely  a  stasis  of 
blood  produced  by  constriction  of  the  veins,  although  it  is 
certain  that  erection  is  strengthened  by  obstruction  to  the 
outflow  of  the  blood  through  the  dorsal  vein  by  the  contrac- 
tion of  the  anterior  fibres  of  the  accelerator  urinae  muscle 
or  the  compressor  venae  dorsalis  of  Houston. 

The  nerves  concerned  in  the  production  of  erection  in 
the  do^,  and  there  is  no  reason  to  doubt  their  existence  in 
man,  arise,  according  to  Eckhard,  by  two  roots,  at  the  sacral 
plexus  from  the  first  to  the  third  sacral  nerves.  Electrical 
stimulation  of  these,  the  erigent  nerves,  is  followed  by  erec- 
tion and  ejaculation,  while  their  division  renders  erection 
and  emission  impossible.  Eckhard,  moreover,  produced 
erection  by  excitation  of  the  lumbar,  and  lower  and  upper 
segments  of  the  cervical  spinal  cord,  the  pons,  and  the 
crura  cerebri,  from  which  he  inferred  that  the  fibres  of  the 
erigent  nerv^es  which  convey  the  impressions  for  erection 
arose  in  the  cerebrum,  and  passed  down  through  the  crura 
and  the  pons  to  the  cord.  Goltz,^  however,  discovered 
that,  after  the  separation  of  the  lumbar  segment  of  the 
cord  from  its  upper  portion,  irritation  of  the  glans  penis 
provoked  a  full  erection,  from  which  he  concluded  that  the 
lumbar  cord  constituted  an  independent  reflex  centre  for 
the  genital  functions  ;  and,  what  is  important  in  the  study 

» 

1  Beitrage  zur  Anat.  und  Phys.,  Bd.  iii.  p.  125,  Bd.  iv.  p.  69,  and  Bd.  vii.  p.  67. 
^  Arbeiten  aus  der  Phys.  Anstatt  zu  Leipzig,  1866,  p.  i. 
*  Pfliiger's  Archiv,  Bd.  viii.  p.  460. 


MECHANISM    OF    ERECTION,  19 

of  psychical  impotence,   he  demonstrated  that  this  centre 
could  be  acted  upon  inhibitorily  from  the  brain. 

From  the  preceding-  considerations  it  is  obvious  that  erec- 
tions in  the  lower  animals  can  be  produced  by  stimulation 
of  the  brain,  the  spinal  cord,  and  the  peripheral  nerves  ;  and 
ample  observations,  both  in  health  and  disease,  demonstrate 
that  they  originate  in  the  same  localities  in  man.  The  in- 
fluence of  certain  emotional  conditions  of  the  mind  over 
erection  is  illustrated  by  its  being  induced  by  sexual  desires, 
or  even  by  the  sight  or  thought  of  certain  women  ;  while  it 
may  be  arrested  or  prevented  by  mental  preoccupation,  or 
by  depressing  emotions,  as  fear  of  inability  to  consummate 
the  venereal  act,  the  loss  of  the  object  of  one's  affections, 
modesty,  disgust,  or  frigidity.  Irritation  of  the  cord,  and 
particularly  of  its  cervical  portion,'  from  disease,  concussion, 
effusion  of  blood,  or  fracture  or  dislocation  of  the  vertebrae, 
frequently  occasions  erections  ;  and  these  may  constitute 
the  first  sign  of  incipient  ataxia,^  or  general  paralysis  of 
the  insane,  and  other  spinal  affections.  As  illustrations  of 
erections  from  peripheral  irritation,  those  arising  from  the 
morning  fulness  of  the  bladder,  from  affections  of  the  rec- 
tum, and  from  inflammation  of  the  prostatic  urethra  and  of 
the  seminal  vesicles  may  be  mentioned. 

The  capacity  for  coition  is  most  marked  between  the 
ages  of  twenty  and  forty-five  years  ;  after  which  it  gradu- 
ally declines,  and  usually  ceases  after  the  sixty-fifth  year. 
Sexual  vigor  is,  moreover,  greatly  diminished  by  bodily 
exertion,  such  as  gymnastic  exercises,  and  by  close  mental 
occupation.     Desire  is  also  obtunded  by  the  same  causes. 


'  OUivier,  Traite  des  Maladies  de  la  Moelle  Epiniere,  3d  ed.,  t.  iii.  p.  316. 
^  Trousseau,  Clin.  Med.  de  I'Hotel-Dieu  de  Paris,  t.  ii.  p.  511  ;  and  Erb, 
Ziemssen's  Cyclopaedia,  Amer.  ed.,  vol.  xiii.  p.  545. 


20  ATONIC    IMPOTENCE. 

Impotence  may  arise  from  diminished  or  abolished  reflex 
excitabihty  of  the  genito-spinal  centre,  or  from  disturbances 
of  the  brain  which  restrain  the  action  of  that  centre  ;  or 
it  may  be  symptomatic  of  the  prolonged  use  of  certain 
remedies  and  beverages,  or  of  various  acute  and  chronic 
diseases  ;  or  it  may  depend  upon  congenital  or  acquired 
defects  of  the  genital  organs.  In  accordance  with  its  etiol- 
ogy it  may,  therefore,  be  described  as  Atonic,  Psychical, 
Symptomatic,  and  Organic.  Of  two  hundred  and  sixty-five 
cases  of  which  I  have  notes,  two  hundred  and  sixty  were 
atonic,  two  were  psychical,  one  was  symptomatic,  and  two 
were  organic. 


Sect.  II.  Atonic  Impotence. 

When  the  lumbar  reflex  centre  for  erection  fails  wholly 
or  partially  to  respond  to  the  ordinary  stimuli  the  resulting 
impotence  may  be  termed  atonic,  in  the  sense  that  the 
centre  is  deficient  in  activity,  mobility,  excitability,  or  toni- 
city, through  which  the  muscular  walls  of  the  arterioles  and 
the  muscular  fibres  of  the  trabeculae  of  the  erectile  tissues 
are  prevented  from  relaxing  and  admitting  the  requisite 
flow  of  blood  into  the  penis,  and  through  which  the  con- 
tractility of  the  ischio-cavernous  and  bulbo-cavernous  mus- 
cles is  impaired. 

Atonic  impotence  depends  either  upon,  or  is  maintained 
by,  inflammation  and  hyperaesthesia  of  the  prostatic  portion 
of  the  urethra,  or  upon  diminished  or  abolished  reflex  ex- 
citability of  the  genito-spinal  centre  without  the  intervention 
of  those  lesions.      Of  the  two  hundred  and  sixty  cases  that 


ETIOLOGY.  21 

have  come  under  my  observation,  two  hundred  and  forty- 
eight  were  of  the  former  variety,  and  only  twelve  of  the 
latter  variety. 


A.— ATONIC  IMPOTENCE  FROM   HYPERyESTHESIA  AND  INFLAM- 
MATION OF  THE  PROSTATIC  URETHRA. 

Etiology. — From  independent  researches,  which  were 
first  published  in  1877,'  I  long  ago  reached  the  conclu- 
sion that  impotence  was  generally  induced  by  subacute  or 
chronic  inflammation  and  morbid  sensibility  of  the  prostatic 
urethra,  which  were  frequently  associated  with  stricture, 
and  which  were  usually  due  to  masturbation,  gonorrhoea, 
sexual  excesses,  and  constant  excitement  of  the  genital 
organs  without  gratification  of  the  passions.  In  subsequent 
papers^  I  called  attention  to  the  fact,  previously  noticed  by 
other  writers,  that  inflammation  of  the  prostatic  urethra 
bears  the  same  relation  to  the  spinal  reflexes  of  the  male 
that  inflammation  of  the  uterus  bears  to  allied  disorders  in 
the  female,  and  that  it  is  a  constant  source  of  irritation  of 
the  genital  nerves  which  terminate  in  that  locality.  An 
enfeebled  state  of  the  lumbar  division  of  the  cord  and  ex- 
haustion of  the  cells  that  minister  to  its  reflex  functions  are 
thus  finally  brought  about. 

In  sixty-three  of  the  two  hundred  and  forty-eight  cases 
the  subjects  had  been  confirmed  masturbators,  and  had  also 
suffered  from  gonorrhoea,  so  that  it  is  impossible  to  say  upon 
which  of  these  factors  the  trouble  depended.  Of  one  hun- 
dred and  eighty-five  patients,  however,  in  whom  the  history 

^  Medical  and  Surgical  Reporter,  May  5,  1877,  p.  391. 

*  Trans.  Amer.  Med.  Assoc,  vol.  28,  p.  523 ;  and  Med.  News  and  Library, 
Sept.  1880,  p.  513. 


22  ATONIC     IMPOTENCE. 

was  clear,  one  hundred  and  thirty  were  masturbators,  fifty- 
one  had  had  gonorrhoea,  two  had  indulged  in  excessive 
coition,  one  had  received  a  blow  on  the  perineum,  and  one, 
who  had  never  masturbated  nor  had  gonorrhoea,  had  fondled 
women  for  four  years.  Just  how  often  prolonged  and  re- 
peatedly ungratified  sexual  excitement  produced  by  toying 
with  females,  as  in  Case  XXI.,  is  to  be  considered  a  cause 
of  the  morbid  changfes  which  induce  or  maintain  the  affec- 
tion  I  am  unable  to  say,  since  young  men  addicted  to  this 
habit  indulge  their  propensities  in  various  ways. 

With  reeard  to  masturbators  who  either  never  had  sexual 
intercourse,  or  had  never  contracted  gonorrhoea,  I  have 
made  some  notes  that  are  interesting  and  practically  impor- 
tant. Thus,  I  find  that  one  in  every  three  has  an  elongated 
prepuce ;  one  in  every  five  has  an  inflamed  meatus ;  one  in 
every  five  has  a  contracted  meatus  ;  one  in  every  two 
and  a  half  has  an  exquisitely  sensitive  urethra  ;  that  the 
same  proportion  suffers  from  prostatic  or  abnormal  seminal 
discharges ;  one  in  every  eleven  has  an  irritable  testis ;  and 
that  one  in  every  ten  has  a  small,  and  usually  a  pointed, 
curved,  and  rigid  penis.  In  the  papers  already  referred  to 
I  endeavored  to  show  that  confirmed  masturbation  is  just  as 
sure  to  result  in  urethritis  and  the  formation  of  a  stricture 
as  is  o-leet ;  and  that  the  failure  to  discover  this  lesion  would 
not  have  occurred  to  the  majority  of  writers  on  this  subject 
if  they  had  resorted  to  the  bulbous  bougie  for  exploring  the 
urethra.  Of  the  one  hundred  and  thirty  masturbators 
who  suffered  from  atonic  impotence,  and  of  the  one  hun- 
dred and  fifty-three  who  had  seminal  incontinence,  as  will 
be  seen  in  the  chapter  on  spermatorrhoea,  or  of  two  hun- 
dred and  eighty-three  in  all,  only  35,  or  12.3  per  cent,  were 
free  from  stricture,  so  that  a  coarctation  should  always  be 
ooked  for  in  this  class  of  subjects.     In   rather  more  than 


ETIOLOGY.  23 

one-half  of  the  cases  there  is  only  one  stricture,  while  in 
the  remainder  two  or  more  are  present.  In  about  three- 
fourths  of  the  entire  number  a  contraction  will  be  found 
near  the  meatus. 

As  the  knowledge  of  the  connection  between  stricture 
of  the  urethra  from  masturbation  and  impotence,  prosta- 
torrhoea,  and  seminal  incontinence  is  of  the  utmost  im- 
portance in  regard  to  the  treatment  of  these  affections,  I 
still  further  extended  my  investigations  in  this  direction  by 
an  examination  of  fifty-six  onanists  in  the  Insane  Depart- 
ment of  the  Philadelphia  Hospital  and  the  Pennsylvania 
Hospital  for  the  Insane.  Of  twenty-seven  inmates  whose 
histories  could  be  traced  back,  eighteen  declared  that  they 
never  had  gonorrhoea.  These  were  either  epileptics,  who, 
when  their  mental  faculties  are  not  enfeebled,  are  as  capa- 
ble of  orivinp"  sensible  accounts  of  themselves  as  others  not 

o  o 

so  affected,  or  the  subjects  of  chronic  insanity  or  dementia, 
of  whom  it  is  characteristic  that,  if  they  remember  anything 
at  all,  they  can  recall  even  the  most  trifling  incidents  that 
may  have  happened  prior  to  the  attack  of  insanity.  In  four 
other  instances  it  was  improbable  that  the  patients  ever  had 
gonorrhoea,  since  they  had  been  imbecile  from  childhood. 
In  the  remaining  five  cases,  the  question  of  gonorrhoea 
could  not  be  entertained,  because  the  subjects  were  ad- 
mitted at  too  early  an  age,  and  had  afterwards  never  left 
the  hospital.     Their  histories  are  briefly  as  follows  : 

Case  I.  An  epileptic,  aged  twenty,  admitted  at  the  age  of  ten, 
had  a  stricture  at  six  inches,  which  was  defined  by  a  No.  i8^  bul- 
bous explorer. 

'■  This  and  the  succeeding  measurements  are  in  accordance  with  the  French 
catheter  scale.  The  cahbre,  therefore,  represents  the  corresponding  number 
of  millimetres  in  circumference,  a  millimetre  being  equal  to  about  the  one- 
twenty-fifth  of  an  inch. 


24  ATONIC     IMPOTENCE. 

Case  II.  An  epileptic,  aged  twenty-three,  had  been  in  the  house 
twelve  years,  having  been  transferred  from  the  Children's  Asylum 
at  the  age  of  eleven.  A  stricture,  calibre  19,  was  detected  at  six 
inches  and  a  half  from  the  meatus,  which  was  contracted;  there 
was  a  gleety  discharge ;  and  the  penis  was  large.     , 

Case  III.  An  epileptic,  aged  thirteen,  an  inmate  for  three  months, 
suffered  from  phimosis,  with  a  stricture,  calibre  17,  at  six  inches  and 
a  half,  and  very  marked  prostatic  hyperaesthesia. 

Case  IV.  An  epileptic,  aged  nineteen,  admitted  at  the  age  of 
eleven,  had  a  stricture,  calibre  19,  at  six  inches,  with  a  very  sensi- 
tive urethra,  and  a  gleety  discharge. 

Case  V.  An  idiot,  aged  fifteen,  an  inmate  for  three  years,  had  a 
gleety  discharge,  and  a  stricture,  calibre  18,  at  five  inches  and  three- 
quarters. 

These  five  cases,  occurring,  as  they  did,  in  young  sub- 
jects, in  whom  the  idea  of  gonorrhoea  must  be  discarded, 
sustain  the  view  heretofore  expressed  that  organic  stricture 
is  a  common  lesion  of  masturbation.  The  coarctations 
imparted  the  sensation  of  a  firm,  resisting  obstacle  upon 
the  withdrawal  of  the  bulbous  explorer,  and  were  distinctly 
recognized  by  my  residents.  Dr.  Murray  and  Dr.  Van 
Valzah,  by  Dr.  Dease,  Dr.  Heath,  and  Dr.  Musser. 

In  addition  to  my  personal  observations  on  the  connec- 
tion between  stricture  and  onanism,  Otis'  states  that  nine 
per  cent,  of  all  cases  are  traceable  to  that  practice.  Ricord, 
Phillips,  Leroy,  Henry  Smith,  Gouley,  and  S.  D.  Gross  also 
mention  masturbation  as  a  cause  of  stricture  ;  and  my  views 
are,  moreover,  supported  by  the  evidence  of  other  authors, 
who  are  more  explicit  in   their  statements   than  those  just 

^  On  Stricture  of  the  Male  Urethra.     Pamphlet,  New  York,  1875. 


ETIOLOGY.  25 

referred  to.  Thus,  Black'  reports  a  typical  case,  associated 
with  hyperaesthesia  of  the  prostatic  urethra,  for  which  he 
was  consulted  on  account  of  fear  of  sexual  incapacity.  In 
speaking  of  the  etiology  of  stricture,  Wade  says  :  "I  have 
good  reason  to  believe  that  the  pernicious  habit  of  self- 
abuse  is  a  much  more  frequent  cause  of  stricture  than  is 
generally  supposed.  In  several  instances  of  the  kind,  in 
which  there  has  been  no  sexual  intercourse,  the  strictures, 
which  were  at  the  bulb,  proved  more  than  usually  refrac- 
tory, from  the  extreme  morbid  sensitiveness  of  the  entire 
urethral  canal."  .  .  .  "The  complication  of  sperma- 
torrhoea with  stricture  and  a  highly  irritable  state  of  the 
urethra  often  proves  very  troublesome,  and  requires  great 
care  and  gentleness  in  its  treatment.  Such  strictures  are, 
in  fact,  not  infrequently  caused  by  masturbation."^  Lizars 
asserts  that  stricture  "is  also  often  produced  by  self-abuse, 
since  we  find,  in  those  affected  with  spermatorrhoea,  that 
there  exists  more  or  less  stricture  of  the  urethra,  for 
which  it  is  necessary  to  dilate  the  canal  before  having  re- 
course to  the  porte-caustique."^  Lallemand^  refers  to  two 
cases  in  masturbators  who  had  never  had  sexual  inter- 
course, in  one  of  which  the  stricture  was  very  tight  and 
rebellious  to  treatment.  Three-quarters  of  a  century  ago, 
Sir  Everard  Home,  in  his  work  on  the  subject,^  devoted  a 
chapter  to  "Strictures  brought  on  by  Onanism,"  but  he 
classified  them  as  spasmodic.     In  thus  recognizing  spasm 

1  On  the  Functional  Diseases  of  the  Renal,  Urinary,  and  Reproductive 
Organs.     Phila.,  1872,  p.  196. 

^  Stricture  of  the  Urethra:  Its  Complications  and  Effects.  4th  ed.,  pp.  21 
and  318. 

^  Practical  Observations  on  the  Treatment  of  Stricture  of  the  Urethra.  2d 
ed.,  p.  I. 

*■  Des  Pertes  Seminales  Involontaires,  t.  i.  p.  479. 

^  Practical  Observations  on  the  Treatment,  etc..  vol.  ii.  p.  243. 


26  ATONIC    IMPOTENCE. 

of  the  urethra  as  an  effect  of  masturbation,  he  described  the 
condition  which  is  the  forerunner  of  permanent  stricture, 
since,  as  is  well  known,  spasmodic  contraction  is  a  very 
common  cause  of  organic  coarctation,  and  is,  indeed,  not 
infrequently  found  in  connection  with  it. 

In  addition  to  the  foregoing  lesions,  masturbation  may 
be  followed  by  other  local  affections,  which  are  due  mainly 
to  the  extension  of  the  morbid  action  from  the  inflamed 
prostatic  urethra.  Among  the  more  common  of  these  are 
irritability  of  the  neck  of  the  bladder,  prostatorrhoea,  noc- 
turnal seminal  discharges,  and  spermorrhagia.  It  may  also 
occasion  spermatocystitis,  funiculitis,  epididymitis,'  asper- 
matism^  through  obstruction  of  the  epididymes  or  vasa 
deferentia,  wasting  of  the  testes,^  and,  as  will  be  pointed  out 
in  the  next  chapter,  it  is  a  fruitful  source  of  azoospermism. 

While  in  persons  with  an  inherited  predisposition  to  ner- 
vous diseases,  as  insanity  and  epilepsy,  there  is  no  reason 
to  doubt  that  onanism  may  hasten  their  appearance,  I  be- 
lieve that  in  the  majority  of  cases  it  should  be  regarded  as 
an  associated  habit,  or  rather  as  the  effect  than  as  the  cause 
of  these  affections.  From  the  constant  occupation  of  the 
mind  with  the  local  troubles  which  it  induces,  it  certainly 
does,  however,  give  rise  to  a  bad  form  of  hypochondrism, 
which  is  akin  to  insanity.  Masturbation  and  sexual  excesses 
are  among  the  most  common  of  the  causes  of  paralytic  de- 
mentia, and  the  disorder  is  supposed  to  extend  upwards 
from  the  cord  to  the  brain.  An  examination  of  four  cases 
of  this  affection  has  convinced  me  that  there  is  a  source  of 


^  See  Case  XV.,  p.  36. 

^  Liegeois,  Medical  Times  and  Gazette,  1869,  vol.  ii.  p.  381  ;  and  Terrillon, 
Annales  de  Dermatologie  et  de  Syphiligraphie,  ser.  2,  t.  i.  p.  439. 

'  Curling,  Diseases  of  the  Testes,  4th  ed.,  p.  78 ;  and  Brodie,  Lend.  Med. 
and  Phys.  Journ.,  vol.  Ivi.  p.  297. 


ETIOLOGY.  27 

reflex  irritability  of  the  cord  in  the  urethra.  In  one,  in  the 
second  stage,  there  was  a  stricture,  calibre  twenty-one,  at 
seven  inches  from  the  meatus.  In  another  instance,  in  the 
first  stage,  there  was  a  large  granular  patch  at  six  inches 
and  a  half,  and  a  gleety  discharge.  A.  similar  condition  was 
detected  at  six  inches  and  a  quarter,  in  a  man  in  the  second 
stage  ;  while,  in  the  fourth  case,  which  was  far  advanced 
in  the  third  stage,  there  was  also  a  granular  patch  at  six 
inches  and  a  half,  and  the  bougie  brought  away  an  abun- 
dant brownish  fluid  from  the  prostatic  urethra.  In  all, 
hyperaesthesia  was  a  marked  symptom.  Whether  these 
morbid  states  served  as  factors  in  the  production  of  the 
disease,  or  simply  hastened  and  maintained  the  nervous 
disturbance,  I  am  unable  to  decide  ;  but,  if  the  former  view 
be  the  correct  one,  functional  conditions  of  the  cord  should 
be  prevented  from  passing  into  organic  changes  by  curing 
the  peripheral  sources  of  irritation  in  the  first  stage  of  the 
affection,  or  when  the  peculiar  gait  and  slight  trouble  in 
speech  are  associated  with  extravagant  ideas.  I  have  never 
known  insanity,  dementia,  or  phthisis  to  follow  onanism,  as 
they  are  said  to  do  by  Krafl^t-Ebig,  Emminghaus,  Skae, 
Ritchie,  Esquirol,  Pinel,  Deslandes,  Maudsley,  Smith,  Acton, 
Bell,  Ray,  Spitzka,  and  other  writers,  nor  have  I  ever  met 
with  the  distressing  cases  described  by  Lallemand  ;  and  I 
fully  agree  with  Sir  James  Paget'  in  the  statements  that 
"  masturbation  does  neither  more  nor  less  harm  than  sexual 
intercourse  practised  with  the  same  frequency  in  the  same 
conditions  of  general  health,  and  age,  and  circumstances," 
and  that  the  ills  which  result  from  it  when  indulged  in  by 
young  persons  are  due  more  to  the  "quantity,  not  the 
method."     Unfortunately,   however,   it  is   begun   earlier  in 

'  Clinical  Lectures  and  Essays,  p.  284. 


28  ATONIC    IMPOTENCE. 

life'  than  coition  ;  and,  as  it  does  not  require  the  cooperation 
of  the  opposite  sex,  it  can  be  practised  to  a  greater  extent, 
and  at  all  times,  and  even  when  erection  is  incomplete. 

Of  the  remaining  remote  causes  of  atonic  impotence, 
namely,  gonorrhoea,  toying  with  females,  and  sexual  ex- 
cesses, which  induce  and  keep  up  hypersesthesia  and 
inflammation  of  the  prostatic  urethra,  it  need  only  be  said 
that  they  are  followed  by  precisely  the  same  lesions  as  are 
met  with  in  masturbation.  In  his  classical  writingrs  on  Dis- 
eases  of  the  Spinal  Cord,  Erb"  declares  that  sexual  excesses 
and  irregularities  occupy  a  prominent  position  in  the  pre- 
disposition to,  and  production  of,  many  spinal  affections, 
among  which  may  be  mentioned  spinal  irritation,  neur- 
asthenia, chronic  meningitis  and  myelitis,  softening,  and 
inflammation  of  the  anterior  horns,  or  poliomyelitis  ;  and 
this  view  is  held  by  many  other  distinguished  authors,  as 
Rosenthal,  Hammond,  and  Romberg. 

Classification. — Atonic  impotence  varies  in  degree,  and 
may  be  divided  into  the  following  classes  : 

First.  The  erection  is,  as  a  rule,  imperfect  and  of  short 
duration,  and,  in  two-thirds  of  the  cases,  ejaculation  is  too 
precipitate,  but  sexual  desire  remains,  and  intercourse  is 
possible,  although  incomplete. 

Second.  The  erection  is  either  so  feeble  that  intromission 
is  impossible,  or  it  is  entirely  absent.  As  in  the  preceding 
form,  desire  is  present. 

^  Fleischmann,  in  the  Wiener  med.  Presse,  1878,  p.  9,  narrates  a  case  in 
which  an  infant  began  to  masturbate  at  nine  months  of  age,  by  crossing  the 
legs  and  setting  up  rocking  motions  of  the  pelvis  and  body  ;  and  Barthez- 
Rilliet,  Marjolin,  Von  Bambecke,  Jacobi,  and  Morton  have  recorded  examples 
in  young  children  who  were  not  sucklings. 

^  Loc.  cit.,  p.  147. 


CLINICAL    HISTORY.  29 

Third.  In  the  last  phase  of  the  affection,  not  only  is  there 
loss  of  power  of  erection,  but  desire  is  completely  abolished. 

Of  the  relative  frequency  of  these  three  varieties  of  im- 
potence, an  examination  of  the  two  hundred  and  forty-eight 
cases  previously  alluded  to  shows  that  two  hundred  and  ten 
were  examples  of  feeble  erection  and  premature  ejacula- 
tion ;  thirty-one  were  instances  of  loss  of  power  of  erection, 
with  retention  of  desire  ;  and  seven  were  examples  of  fail- 
ure of  both  erection  and  desire ;  so  that  I  have  no  hesita- 
tion in  declaring-  that  the  first  form  is  more  common  than 
impotence  from  all  other  causes  combined. 

Clinical  History. — As  my  readers  will  gain  a  better 
insight  into  the  peculiarities  of  the  three  varieties  by  a  nar- 
ration of  cases  than  by  a  general  and  abstract  description, 
I  append  some  typical  examples. 

Case  VI.  A  grocer,  twenty-two  years  of  age,  consulted  me  on 
the  1 2th  of  October,  1876,  on  account  of  impaired  erections  and 
premature  ejaculation.  He  began  to  masturbate  at  the  age  of  four- 
teen, and  continued  the  practice  for  three  years.  Its  abandonment 
was  followed  by  nocturnal  seminal  emissions  of  an  intermittent 
character,  that  is  to  say,  they  recurred  almost  every  night  for  a 
fortnight,  when  there  was  an  intermission  of  a  week's  duration.  He 
had  been  under  treatment  for  two  years  before  coming  to  me,  the 
effect  of  which  was  to  improve  his  general  health  and  materially 
lessen  the  frequency  of  the  nocturnal  discharges.  Up  to  one  year 
ago  he  had  never  had  sexual  intercourse.  At  the  time  he  found 
that  erection  was  incomplete,  the  gland  of  the  penis,  in  particular, 
being  soft  and  inelastic,  and  that  ejaculation  took  place  in  a  few 
seconds.  The  same  troubles  had  existed  ever  since.  During  the 
past  two  months,  nocturnal  emissions  had  occurred  from  one  to  five 
times  a  week,  and  he  noticed  that  flakes  of  mucus,  which  he  sup- 
posed to  be  semen,  were  discharged  in  advance  of  the  stream  of 
urine.     He  was  easily  fatigued,  his  hand  was  unsteady  in  writing. 


30  ATONIC    IMPOTENCE, 

he  was  habitually  constipated,  and  he  suffered  from  dull,  heavy 
pains  in  the  groins  and  back. 

Examination  with  the  bulbous  explorer  disclosed  slight  tender- 
ness of  the  urethra  half  an  inch  from  the  meatus,  and  decided  ten- 
derness at  four  inches  and  a  half,  which  increased  as  the  prostatic 
urethra  was  reached.  On  withdrawing  the  instrument,  a  stricture, 
calibre  lo,  was  detected  at  five  inches  and  a  quarter  from  the 
meatus.  The  bulb  brought  out  a  whitish  fluid,  which  showed, 
under  the  microscope,  a  large  amount  of  pus  and  epithelium.  The 
urine  was  acid,  and  loaded  with  lithates,  but  the  genital  organs 
were  normal. 

I  prescribed  a  laxative  pill,  to  be  taken  as  often  as  it  might  be 
required,  warm  hip-baths,  and  warm  enemata  night  and  morning, 
and  thirty  grains  of  bromide  of  potassium  every  eight  hours.  The 
diet  was  restricted  to  perfectly  bland  and  digestible  articles;  sexual 
intercourse  and  stimulating  drinks  were  interdicted;  and  an  injec- 
tion of  one  drachm  of  Goulard's  extract  to  ten  ounces  of  water 
was  directed  to  be  thrown  into  the  urethra  three  times  a  day. 

On  the  14th  I  passed  a  No.  10  steel  bougie,  and  continued  its 
introduction  every  second  day  until  the  26th,  when  it  was  employed 
once  every  twenty-four  hours  by  the  patient  himself.  At  first  it 
was  immediately  withdrawn,  but  as  the  sensibility  of  the  urethra 
became  obtunded,  it  was  permitted  to  remain  longer,  but  at  no 
time  more  than  five  minutes.  The  size  was  gradually  increased, 
until  toward  the  close  of  the  treatment  it  reached  No.  27.  During 
the  first  week  there  were  three  nocturnal  emissions;  but  from  that 
time  until  I  discharged  the  patient,  on  the  3d  of  December,  when 
his  sexual  powers  were  entirely  regained,  there  was  only  one.  I 
saw  this  man  again  early  in  January,  1877,  on  account  of  a  chancre, 
when  he  informed  me  that  he  had  experienced  no  trouble  whatever 
in  sexual  congress. 

Case  VIL  A  mechanic,  twenty- six  years  of  age,  states  that  he 
has  had  intercourse  with  one  woman  three  or  four  times  every  night 
for  the  past  eighteen  months,  and  that  he  occasionally  fulfilled  en- 
gagements of  a  similar  nature  with  other  females.  He  had  never 
masturbated  much,  nor  had  he  ever  contracted  gonorrhoea.     Lately 


CLINICAL    HISTORY.  31 

he  has  observed  that  his  powers  were  growing  feeble ;  and  at 
present  the  erections  are  flabby,  and  the  ejaculations,  when  pene- 
tration is  possible,  are  precipitate.  He  looks  pale,  is  easily  fatigued, 
and  suffers  from  pain  in  the  back,  and  from  frequent  and  painful 
micturition.  A  No.  25  explorer  detects  a  very  sensitive  urethra, 
and  a  stricture  seated  at  six  inches  from  the  meatus.  The  neck 
of  the  bladder  is  so  sensitive  that  it  contracts  when  the  instrument 
comes  in  contact  with  it,  so  that  its  onward  progress  is  momen- 
tarily arrested. 

Case  VIII,  A  weaver,  thirty-seven  years  of  age,  has  had  gonor- 
rhoea three  times,  the  last  attack  having  occurred  fourteen  years 
ago.  For  the  past  three  years  he  has  noticed  that  the  erections 
were  becoming  more  and  more  feeble,  until  they  frequently  passed 
of  before  intromission,  and  coition  was  always  attended  with  hasty 
emission.  In  addition  to  his  sexual  troubles,  he  complains  of 
numbness  along  the  outer  side  of  the  left  thigh,  almost  constant 
dorsal  pain,  and  a  dull,  heavy  pain  in  the  back  of  the  head,  the 
left  side  of  the  neck,  and  the  left  shoulder,  all  of  which  localities 
now  and  then  suddenly  become  red  and  hot.  The  suffering  is 
aggravated  by  exercise  and  continuous  work ;  his  sleep  is  unre- 
freshing,  and  he  has  dyspeptic  symptoms.  He  has  two  strictures, 
the  first  of  which,  calibre  17,  is  located  at  three  inches  and  a  half, 
and  the  second,  calibre  15,  is  six  inches  from  the  meatus;  and  the 
prostatic  urethra  is  morbidly  sensitive. 

In  the  preceding  illustrations  of  >the  first  variety  of  atonic 
impotence,  the  exciting  causes  vv^ere  chronic  hyperaesthesia 
and  inflammation  of  the  prostatic  urethra,  w^hich  were  pro- 
duced, respectively,  by  masturbation,  by  sexual  excesses, 
and  by  gonorrhoea,  and  were  maintained  by  one  or  more 
strictures.  One  case  was  complicated  by  nocturnal  emis- 
sions, and  another  by  inflammation  of  the  neck  of  the 
bladder  ;  and  in  all  there  were  symptoms  of  neurasthenia. 

In  this  form  of  the  affection  may  be  included  the  condition 
known   as   irritable   weakness,    spasmodic    spermatorrhoea, 


32  ATONIC     IMPOTENCE. 

prospermatism,  or  spermaspasmos,  in  which,  the  erection 
being  more  or  less  complete,  ejaculation  occurs  before 
penetration,  simultaneously  with  erection,  or  even  before 
erection.  It  is  most  common  in  men  who  are  much  excited 
on  entering  upon  sexual  congress,  in  pronounced  mastur- 
bators  who  suffer  from  nocturnal  pollutions,  and  in  subjects 
of  ungratified  desire  from  toying  with  women.  In  the  lesser 
grade  of  the  trouble,  the  ejaculation  is  premature  only  on 
the  first  attempt  at  intercourse,  the  succeeding  ones  being 
properly  completed.  Some  of  these  points  are  illustrated 
by  the  following  cases  : 

Case  IX.  A  merchant,  thirty-seven  years  of  age,  had  masturbated 
up  to  his  eighteenth  year,  and  has  been  in  the  habit  of  toying  with 
women  ever  since.  At  his  first  attempt  at  connection,  which  took 
place  when  he  was  twenty-nine  years  old,  he  found  that  the  erection 
was  imperfect,  and  that  ejaculation  occurred  before  intromission; 
and  he  stated  that  these  troubles  still  continued.  There  was  a 
stricture,  calibre,  i8,  at  six  inches  from  the  meatus,  and  the  pros- 
tatic urethra  was  exquisitely  sensitive. 

Case  X.  A  clerk,  thirty  years  of  age,  brought  me  a  specimen  of 
urine  for  examination,  which  I  found  to  contain  an  abundance  of 
motionless  spermatozoa,  oxalate  of  lime,  and  a  few  pus  corpuscles 
and  epithelial  cells.  He  never  had  gonorrhoea,  but  he  had  mas- 
turbated from  his  sixteenth  to  his  twenty-first  year,  on  an  average, 
twice  a  day.  There  was  a  constant  sticky  feeling  at  the  meatus, 
and  he  informed  me  that  for  the  past  three  years,  whenever  he 
attempted  sexual  intercourse,  he  had  an  erection,  with  a  simulta- 
neous emission.  The  hands  and  feet  were  habitually  cold,  and  he 
had  no  knowledge  of  nocturnal  emissions  for  five  years.  The  ex- 
.  plorer  detected  a  stricture,  calibre  17,  at  six  inches  and  a  half  from 
the  meatus,  and  there  was  marked  hyperaesthesia  of  the  prostatic, 
urethra. 


CLINICAL    HISTORY.  33 

Case  XI.  A  physician,  thirty-four  years  of  age,  had  masturbated 
from  his  fifteenth  to  his  seventeenth  year,  and  had  contracted  gon- 
orrhoea eleven  years  ago.  For  ten  years  he  was  unable  to  have 
connection,  in  consequence  of  ejaculations  at  the  moment  of  pene- 
tration ;  and  for  the  past  three  years  emission  occurred  before 
erection,  and  he  had  nocturnal  pollutions  from  two  to  three  times 
a  week.  The  meatus  would  admit  only  a  No.  17  explorer;  but 
after  its  enlargement,  a  stricture,  calibre  25,  was  discovered  at  six 
inches  and  one-eighth,  and  the  prostatic  urethra  was  very  sensitive. 

The  subjoined  illustrations  are  good  examples  of  the 
second  variety  of  impotence,  or  of  that  in  which  desire  is 
retained,  but  in  which  the  power  of  erection  is  lost,  and 
coition  is  impossible. 

Case  XII.  A  tavern-keeper,  thirty-two  years  of  age,  of  robust 
frame,  stated  that  he  was  engaged  to  be  married  in  six  weeks;  that 
he  could  not  command  an  erection,  although  he  had  sexual  desires; 
that  the  presence  of  the  object  of  his  affections,  and  the  most  las- 
civious books  and  pictures,  which  formerly  brought  on  an  erection, 
had  lost  that  effect ;  and  that  the  thought  of  his  disability  on  his 
wedding-night  was  constantly  preying  on  his  mind.  This  condi- 
tion of  affairs  had  existed  for  five  months,  during  which  time  he  had 
nocturnal  seminal  emissions  about  twice  a  week.  He  was,  more- 
over, much  alarmed  at  the  presence  of  some  shreds  of  purulent 
mucus  in  his  urine,  which  he  thought  was  seminal  fluid.  He  had 
three  attacks  of  gonorrhoea,  the  last  of  which  occurred  seven  years 
ago,  since  which  period  he  has  always  had  a  slight  gleety  dis- 
charge, and  for  the  past  few  months  a  dribbling  of  a  few  drops  of 
urine  in  his  clothes  after  the  act  of  micturition  was  apparently 
completed.  He  suffered  from  habitual  constipation,  but  in  other 
respects  he  was  the  picture  of  health. 

The  bulbous  explorer  defined  two  strictures,  calibre  23,  located, 
respectively,  at  six  inches,  and  at  six  inches  and  a  half,  from  the 
external  meatus,  as  well  as  marked  hypersesthesia  of  the  prostatic 
urethra. 

3 


34  ATONIC    IMPOTENCE. 

Case  XIII.  A  mechanic,  twenty-three  years  of  age,  at  about  his 
sixteenth  year,  after  having  been  in  the  habit  of  masturbating  freely 
for  six  or  seven  years,  observed  a  urethral  discharge.  He  had  never 
had  sexual  intercourse  until  he  was  twenty-one ;  and,  after  a  few 
months  of  moderate  indulgence,  the  discharge  had  increased,  and 
the  erections  had  become  more  and  more  weak,  until  he  was  finally 
unable  to  consummate  the  act,  although  the  desire  remained.  He 
is  pale ;  suffers  much  from  pain  in  the  back,  the  shoulders,  the 
anus,  and  the  left  temporo-maxillary  articulation ;  and  is  easily 
fatigued. 

Examination  with  a  No.  25  explorer  disclosed  intense  hyperaes- 
thesia  of  the  entire  urethra,  and  particularly  of  its  prostatic  portion, 
but  there  was  no  indication  of  a  stricture.  As  soon  as  the  instru- 
ment entered  the  passage  it  occasioned  tremor  and  retraction  of 
the  testes,  and  when  it  reached  the  prostatic  portion  he  shrank 
from  the  excessive  suffering  which  it  awakened,  and  the  muscles 
of  the  lids,  nose,  and  mouth  twitched  convulsively.  On  its  with- 
drawal, the  bulb  brought  away  a  considerable  prostatic  discharge. 
He  afterwards  rode  to  his  house  in  the  street  cars,  and  about  two 
hours  later,  after  urinating,  he  was  seized  with  a  curious  crawling 
sensation  in  his  arms  and  legs,  lost  consciousness,  and,  when  found 
by  his  friends,  was  lying  on  the  floor,  and  his  face  was  livid.  Three 
days  subsequently,  he  was  placed  upon  thirty  grains  of  bromide  of 
potassium,  with  five  drops  each  of  juice  of  belladonna  and  tincture 
of  gelsemium,  every  eight  hours,  and  directed  to  take  ten  grains  of 
quinia  one  hour  before  his  next  visit,  which  occurred  one  week 
ago.  At  that  time  a  conical  steel  bougie  was  passed,  and  one-third 
of  a  grain  of  morphia  thrown  under  the  skin.  A  slight  epileptoid 
paroxysm,  as  indicated  by  clonic  spasms  of  the  muscles  of  the 
arms  and  eyelids,  and  a  feeling  as  if  he  would  become  unconscious, 
ensued;  and  these  symptoms  were  followed  by  prostration  and 
numbness  of  both  hands. 

In  the  third  phase,  or  as  it  is  sometimes  called  the  para- 
lytic form,  of  the  affection,  erection  and  desire  are  completely 
abolished,  as  is  illustrated  by  the  following  instances  : 


CLINICAL    HISTORY.  35 

Case  XIV.  A  medical  student,  twenty-four  years  of  age,  had 
masturbated  excessively  for  six  years,  and  for  the  past  two  years, 
during  which  period  he  had  discontinued  the  practice,  had  noc- 
turnal seminal  emissions,  on  an  average,  twice  a  week.  When  I 
saw  him  he  stated  that  he  had  lost  all  desire,  and  had  been  unable 
to  command  an  erection  for  three  months.  He  was  very  watchful 
of  a  gleety  discharge,  and  brought  with  him,  for  my  inspection,  a 
specimen  of  urine  which  contained  little  threads  of  mucus,  which 
he  imagined  to  be  semen.  His  general  health  was  broken;  his 
expression  was  woe-begone ;  he  was  gloomy,  shy,  and  reserved, 
and  unable  to  fix  his  attention  upon  his  studies,  and  easily  fatigued. 
He  was  constantly  thinking  of  his  previous  bad  habit  and  the  noc- 
turnal emissions,  and  was  convinced  that  his  condition  was  beyond 
relief     In  a  word,  he  was  a  victim  of  sexual  hypochondrism. 

The  external  genital  organs,  and  the  prostate  and  seminal  vesi- 
cles, as  far  as  rectal  touch  enabled  me  to  form  an  opinion,  were 
perfectly  normal;  but  the  urinary  meatus  was  constantly  moist, 
and  its  lips  were  red  and  pouting.  At  five  inches  and  three-quar- 
ters from  the  meatus  I  detected  a  stricture,  calibre  17,  and  also 
found  that  the  urethra  behind  it  was  extremely  sensitive.  Placing 
a  little  of  the  fluid,  which  was  withdrawn  by  the  explorer,  under 
the  microscope,  I  demonstrated  to  my  patient  that  it  was  free  from 
spermatozoa,  and  I  still  further  endeavored  to  gain  his  confidence 
by  assuring  him  that  his  disability  was  temporary,  since,  from  its 
dependence  upon  appreciable  lesions,  it  could  be  cured.  Under 
appropriate  treatment,  in  three  weeks,  the  pollutions  had  decreased 
in  frequency,  the  prostatic  discharge  had  lessened  in  quantity,  the 
hyperaesthesia  had  notably  diminished,  and  he  had  begun  to  have 
feeble  erections.  At  the  expiration  of  a  month  I  divided  the  stric- 
ture, and  he  went  with  me  to  the  seashore.  In  three  weeks,  or 
eleven  weeks  from  the  commencement  of  the  treatment,  he  had 
good  erections,  and  his  mental  anxiety  was  calmed,  but,  unfortu- 
nately, he  desired  to  test  his  powers,  and  had  an  almost  instan- 
taneous ejaculation  with  cessation  of  erection.  This  act,  which  he 
undertook  entirely  on  his  own  responsibility,  undid  all  the  good  I 
had  effected ;  and  it  was  only  after  the  expiration  of  eight  months 
that  he  finally  recovered  under  the  employment  of  galvanism. 


86  ATONIC    IMPOTENCE. 

Case  XV.  A  druggist,  twenty-four  years  of  age,  came  to  me  on 
account  of  vesical  irritability,  under  which  he  had  labored  for  six 
years.  He  has  never  had  sexual  intercourse,  but  had  masturbated 
from  boyhood  until  his  twentieth  year,  and  desire  and  power  of 
erection  had  been  abolished  for  nearly  four  years.  The  entire 
urethra  and  neck  of  the  bladder  were  excessively  sensitive,  and  a 
stricture,  calibre  17,  was  detected  at  six  inches  and  one-fifth  from 
the  meatus,  which  measured  thirty-three  millimetres  in  circumfer- 
ence. The  epididymes,  but  especially  the  right,  were  enlarged 
and  indurated. 

In  the  majority  of  cases  of  atonic  impotence  which  I  have 
inserted  for  the  purpose  of  illustrating  the  various  phases 
of  the  affection,  in  addition  to  the  lesions  of  the  urethra,  it 
will  have  been  perceived  that  certain  subjective  symptoms 
were  present,  which  were  indicative  of  spinal  exhaustion, 
the  depressed  form  of  spinal  irritation,  or  neurasthenia. 
Prominent  among  these  signs  are  pain  in  the  back,  which 
is  increased  by  exercise,  exposure  to  atmospheric  vicissi- 
tudes, and  attempts  at  coition,  and  muscular  weakness  of 
the  limbs,  so  that  the  subjects  are  tired  out  by  compara- 
tively slight  exertions  and  walking.  These  symptoms 
point,  to  use  a  term  introduced  by  Beard,'  to  myelasthenia 
of  the  lumbar  division  of  the  cord.  In  a  certain  number  ol 
examples,  as  in  Case  VIII.,  there  is  dull,  heavy  pain  in  the 
frontal  region,  the  back  of  the  head,  the  neck,  and  shoul- 
ders, which  now  and  then  become  flushed,  si^ns  which  are 
indicative  of  exhaustion  of  the  upper  portion  of  the  cord.  In 
other  instances,  the  symptoms  are  those  of  cerebrasthenia, 
such  as  impairment  of  memory,  mental  debility,  depression, 
anxiety,  or  irritability,  a  feeling  of  fulness  in  the  head, 
asthenopia,  and  other  disorders  of  the  special  senses  ;  all 

^  A  Practical  Treatise  on  Nervous  Exhaustion,  2d  ed.,  p.  106 ;  and  Medical 
Record,  1879,  vol.  i.  p.  184. 


DIAGNOSIS. 


37 


Fig.  I. 


of  which  are  signs  of  enfeeblement  of  the  functional  power 
of  the  brain,  and  which  may  be  readily  explained  by  the 
commissural  connections  between  the  lumbar  division  of 
the  cord  and  the  higher  centres.  In  other  cases,  again,  the 
symptoms  are  variously  interwoven  ;  and 
in  all  troubled  and  un refreshing  sleep,  a 
feelinor  of  heaviness  on  rising,  coldness 
of  the  hands  and  feet,  poor  appetite, 
coated  tongue,  flatulence,  a  sense  of 
weight  in  the  epigastrium  after  eating, 
palpitation  of  the  heart,  sick  headache, 
vertigo,  and  constipation,  are  very  com- 
mon. In  addition  to  the  various  phe- 
nomena of  neurasthenia  and  dyspepsia, 
nocturnal  emissions  and  prostatorrhoea 
are  frequently  met  with. 

Diagnosis. — The  diag-nosis  of  atonic 
impotence  is  readily  made  from  a  con- 
sideration of  the  preceding  observations. 
In  all  cases  the  urethra  should  be  ex- 
amined with  the  view  of  determining  the 
presence  or  absence  of  lesions  which 
induce  or  maintain  the  disorder.  For 
this  purpose,  the  exploratory,  or  acorn- 
headed,  soft  bougie,  represented  in  Fig. 
I,  should  be  resorted  to,  as  it  is  the  only 
instrument  with  which  granular  patches  and  strictures  of 
large  calibre  can  be  accurately  defined,  and  with  which 
morbid  discharges  can  be  withdrawn  for  minute  examina- 
tion. One  being  selected  which  fills,  without  unpleasantly 
stretching,  the  meatus,  it  is  well  oiled  and  inserted  as  far 
as  the  bladder.     If  there  be  a  coarctation,  its  introduction 


Exploratory  bulbous 
bougie. 


88  ATONIC    IMPOTENCE. 

will  be  arrested,  when  smaller  sizes  are  successively  em- 
ployed, until  one  will  pass  without  difficulty.  On  its  with- 
drawal, the  abrupt  shoulder  of  the  bulb  coming  in  contact 
with  the  posterior  face  of  the  obstruction  imparts  to  the 
touch  a  sensation  as  if  it  had  jumped  over  a  narrow  band, 
which  is  as  perceptible  to  the  patient  as  it  is  to  the  surgeon, 
and  is  very  different  from  the  sensation  conveyed  by  spasm. 
In  the  latter,  the  instrument  may  be  grasped  for  a  time, 
but  the  muscular  contractions  soon  cease,  or  may  be  made 
to  cease  by  carrying  the  bulb  several  times  through  the 
obstruction  ;  while  a  granular  patch  gives  the  impression 
of  a  limited  roughness  of  the  canal. 

Hyperaesthesia  of  the  urethra  is  readily  detected  by  the 
ordinary  metallic  bougie,  catheter,  or  sound  ;  and  its  exist- 
ence should  never  be  based  upon  the  passage  of  the  soft 
explorer  alone,  as  the  insertion  of  that  instrument  is  pro- 
ductive of  far  more  pain  than  the  ordinary  nickel-plated 
bougie.  If  the  surgeon  should  deem  it  desirable,  he  may 
confirm  his  diagnosis  by  a  resort  to  the  endoscope,  with 
which  Grunfeld'  has  discovered  hypersemia  and  catarrhal 
swelling  of  the  verumontanum  in  cases  of  impotence,  pros- 
tatorrhoea,  and  spermatorrhoea.  I  myself  never  employ  it, 
nor  do  I  think  that  any  additional  information  is  to  be 
gained  from  its  use. 

In  the  absence  of  proper  instruments  for  exploring  the 
urethra,  the  general  practitioner  may  suspect  inflammation 
and  morbid  sensibility  if  there  be  painful  and  frequent 
micturition,  painful  ejaculation,  a  feeling  of  weight  in  the 
anorectal  region,  a  gleety  discharge,  prostatorrhoea,  abnor- 
mal nocturnal  emissions,  and  sensibility  of  the  prostate  on 
pressure  with  the  finger  in  the  rectum. 

^  Endoskopische  Befunde  bei  Erkrankungen  des  Samenhiigels.    Wien,  1880. 


PROGNOSIS.  39 

Prognosis. — The  milder  forms  of  impotence  are  very 
amenable  to  treatment,  as  is  illustrated  by  the  following 
example  : 

Case  XVI.  A  carriage-builder,  twenty-three  years  of  age,  came 
to  me  on  the  8th  of  April,  1880,  on  account  of  a  gleety  discharge, 
which  kept  the  lips  of  the  meatus  glued  together,  and  had  existed 
for  two  years  and  a  half;  of  a  discharge  of  prostatic  fluid  at  stool; 
and  of  nocturnal  seminal  emissions,  which  were  often  as  frequent 
as  every  night  during  a  single  week,  now  and  then  occurring  to 
the  number  of  three  in  a  night,  and  averaging  three  a  week.  The 
erections  were  feeble,  and  ejaculation  was  premature.  The  bowels 
were  costive,  but  he  had  no  signs  of  spinal  exhaustion.  Examina- 
tion with  a  No.  17  explorer  disclosed  a  stricture  one-eighth  of  an 
inch  behind  a  contracted  meatus,  and  a  highly  sensitive  urethra, 
especially  in  its  membranous  and  prostatic  divisions.  On  with- 
drawing the  instrument,  a  few  drops  of  prostatic  fluid  came  away. 
I  laid  open  the  meatus  along  with  the  stricture,  and  directed  a  pill 
composed  of  two  grains  of  compound  extract  of  colocynth  and 
half  a  grain  of  extract  of  nux  vomica  at  bedtime,  along  with  the 
one-sixtieth  of  a  grain  of  atropia  in  solution,  and  thirty  grains  of 
bromide  of  potassium  every  eight  hours.  The  incision  was  pre- 
vented from  closing  by  the  passage  of  a  No.  30  conical  steel  bougie, 
which  was  carried  through  the  entire  urethra  every  other  day.  On 
the  6th  of  May,  the  hypersesthesia  had  almost  entirely  disappeared ; 
the  gleet  had  ceased  ;  there  was  merely  a  slight  prostatic  discharge, 
if  the  bowels  were  allowed  to  become  constipated,  but  he  had  not 
noticed  it  for  several  days  ;  there  were  nocturnal  emissions  on  the 
nights  of  April  17  and  18,  and  the  erections  were  improving  in  vigor. 
The  treatment  was  continued,  and  a  cure  was  effected  in  another 
month. 

This  case  is  not  a  selected  one  ;  and  whenever  a  patient 
presents  himself  who  has  erections  and  desire,  even  if  he 
has  a  prostatic  discharge,  or  too  frequent  nocturnal  pollu- 
tions, or  is  suffering  with  both  of  these  complications,  the 


40  ATONIC    IMPOTENCE. 

surgeon  will  be  perfectly  justifiable  in  promising  relief.  In 
the  second  variety  of  the  affection,  in  which  desire  remains, 
but  in  which  the  erections  are  so  feeble  that  penetration  is 
impossible,  or  are  entirely  absent,  it  is  not  uncommon  for 
the  man  to  have  an  erection  and  emission  under  the  influ- 
ence of  a  voluptuous  dream,  thereby  showing  that  the 
sexual  instinct  is  not  entirely  lost.  In  such  a  case  as  this 
the  prognosis  is  also  favorable,  although  the  patient  will 
have  to  remain  longer  under  treatment.  When  both  desire 
and  erection  are  abolished,  and  the  man  is  suffering  from 
hypochondrism,  the  outlook  is  bad,  particularly  if  we  cannot 
gain  his  confidence,  and  he  is  not  open  to  moral  treatment. 
In  this  class  of  cases,  if  there  is  neither  hypochondrism  nor 
neurasthenia,  the  prognosis  is  good.  In  Case  XII.,  which 
was  an  example  of  the  latter  condition,  I  divided  the  stric- 
tures on  the  nth  of  September,  and  placed  the  man  upon 
bromide  of  potassium  and  tincture  of  veratrum  viride,  a 
laxative  pill,  as  it  might  be  required,  warm  sitz-baths,  and' 
a  restricted  diet,  and  enjoined  abstinence  from  everything 
which  was  calculated  to  excite  the  genital  organs.  He 
married  on  the  6th  of  November,  having  in  the  meanwhile 
passed  a  No.  32  conical  steel  bougie  every  twenty-four 
hours  until  the  tenderness  of  the  prostatic  urethra  had  dis- 
appeared, and  he  wrote  me  five  days  subsequently  that  he 
had  had  connection  every  night.  I  cautioned  him  against 
committing  such  marital  excess,  lest  sexual  abuse  might 
cause  a  relapse. 

The  prognosis  is  not  so  good  when  the  disorder  arises 
from  excessive  onanismi  commenced  early  in  life  by  ner- 
vous, impressible  boys.  When  impotence  is  developed 
after  the  age  of  forty,  the  patient  should  be  made  to  under- 
stand that  his  pristine  vigor  can  scarcely  be  expected  to  be 


TREATMENT.    .  41 

restored,  since  the  power  to  copulate  naturally  diminishes 
at  that  age. 

Treatment. — In  the  management  of  atonic  impotence,  a 
thorough  examination  of  the  genital  and  associated  organs 
should  be  made,  with  a  view  of  getting  rid  of  the  causes 
which  produce  and  maintain  it.  If  the  patient  has  a  redun- 
dant prepuce,  it  should  be  removed  ;  if  the  meatus  be 
contracted,  it  should  be  enlarged ;  while  herpes  of  the 
prepuce  and  glans,  or  balanitis,  should  be  treated  in  the 
usual  way.  All  of  these  lesions  are  capable  of  setting  up 
hypersesthesia  of  the  prostatic  portion  of  the  urethra,  or 
even  of  exciting  reflex  impotence  without  the  intervention 
of  prostatic  trouble,  and  their  relief  is  quite  sufficient  in 
mild  cases  to  brino-  about  a  cure.  The  same  statement  is 
true  of  certain  diseases  of  the  bladder  and  rectum,  so  that 
these  viscera  should  not  be  overlooked. 

Atonic  impotence  usually  occurs  in  robust  subjects,  in 
whom  inflammation  and  morbid  sensibility  of  the  prostatic 
portion  of  the  urethra  have  set  in  before  the  signs  of  myel- 
asthenia  are  pronounced,  the  usual  symptom,  according 
to  my  experience,  being  pain  in  the  back.  Hence  the 
treatment,  whether  this  be  local  or  general,  must  be  of  a 
sedative  nature  ;  and  the  patient,  at  the  outset,  should  be 
impressed  with  the  importance  of  avoiding  all  sources  of 
sexual  excitement,  such  as  masturbation,  attempts  at  inter- 
course, dalliance  with  women,  and  lascivious  thoughts  and 
literature  ;  and  if  his  sexual  propensities  are  marked,  they 
should  be  kept  under  control  by  mental  application  and 
gymnastic  exercises. 

Of  the  local  iiieasui'-es  to  overcome  hypersemia,  inflamma- 
tion, and  hypersesthesia  of  the  prostatic  urethra,  not  one  is 
so  universally  applicable  as  the  passage  of  the  nickel-plated 


42 


ATONIC    IMPOTENCE. 


conical  steel  bougie  represented  in  Fig.  2.  The  size  of  the 
instrument  is  to  be  gauged  by  that  of  the  meatus,  if  it  be 
normal,  or  by  that  of  the  stricture,  if  one  be  present,  and 


Fig.  2. 


Fig.  3. 


Fig.  d. 


U 


Conical  steel  bougie. 


Author's  urethral  dilator. 


Author's  urethrotome. 


its  circumference  should  be  gradually  increased  up  to  that 
of  the  full  capacity  of  the  urethra,  as  indicated  by  the  ure- 
thrameter.     To  effect  this,  however,  the  meatus  will  have 


TREATMENT.  43 

to  be  enlarged  as  a  preliminary  measure  ;  or,  instead  of 
this,  my  urethral  dilator,  represented  in  Fig.  3,  which  dis- 
penses with  the  operation,  may  be  employed,  although  it  is 
much  less  efficacious  than  the  bougie.  At  first  the  bougie 
should  be  at  once  withdrawn,  and  the  intervals  between 
the  insertions  should  be  seventy-two  hours.  With  the  de- 
crease of  the  sensibility  it  should  be  retained  longer,  and 
the  intervals  of  introduction  be  shortened  until  it  is  passed 
daily. 

If  the  case  is  complicated  by  an  irritable  or  resilient 
stricture,  it  should  be  subjected  to  internal  division  from 
behind  forward,  as  no  progress  can  be  made  unless  the 
contraction  is  a  simple  one.  For  this  purpose,  I  prefer  the 
instrument  devised  by  myself  several  years  ago,  as  I  have 
found  from  ample  experience  that  its  simplicity  of  construc- 
tion and  perfection  of  action  leave  nothing  to  be  desired. 
The  essential  part  of  the  contrivance  is  its  acorn-headed 
distal  extremity,  through  which  the  situation  of  the  coarcta- 
tion Is  accurately  determined.  To  use  the  exploratory 
urethrotome,  the  stricture  having  been  passed,  and  its  pos- 
terior face  having  been  defined  by  the  projecting  shoulder 
of  the  bulb,  the  bulb  is  carried  at  least  half  an  inch  toward 
the  bladder,  as  the  object  is  to  divide,  along  with  the  con 
traction,  the  sound  tissues  to  that  extent  behind  and  in  front 
of  it ;  then  the  blade  is  protruded,  as  in  Fig.  4,  and  the 
parts  cut  as  the  instrument  is  withdrawn,  the  penis  being 
put  upon  the  stretch  to  render  the  urethra  tense.  In  the 
event  of  the  tissues  being  thick  or  resistant,  the  section 
may  be  materially  aided  by  counterpressure  with  the  fingers 
of  the  left  hand  along  the  median  line.  The  bulb  is  then 
used  as  an  explorer  to  detect  any  undivided  bands,  which, 
if  discovered,  should  be  severed,  since  thorough  section  of 
all  narrowed  points  is  essential  to  success.     In  regard  to 


44  ATONICIMPOTENCE. 

the  subsequent  treatment,  I  need  only  refer  to  my  views 
published  elsewhere/  as  its  consideration  would  be  out  of 
place  here. 

It  now  and  then  happens,  as  in  Case  XIII, ^  that  the  entire 
urethra  is  so  excessively  sensitive  that  the  introduction  of 
the  bougie  is  followed  by  an  epileptoid  paroxysm,  or  that 
the  patient  faints.  Under  the  circumstances,  it  is  more 
judicious  to  desist  from  its  use  until  the  sensibility  of  the 
passage  has  been  obtunded  by  the  injection,  every  eight 
hours,  of  three  grains  of  chloral,  and  ten  grains  of  bromide 
of  potassium  to  the  ounce  of  water,  and  by  the  internal 
exhibition,  at  the  same  intervals,  of  thirty  grains  of  the 
bromide,  ten  drops  of  tincture  of  cannabis  indica,  and  five 
drops  of  tincture  of  gelsemium,  and  by  sitz-baths  of  water 
as  warm  as  it  can  be  borne.  It  will  also  be  wise  to  throw 
into  the  deep  urethra,  about  ten  minutes  before  inserting 
the  bougie,  a  drachm  of  a  four  per  cent,  solution  of  cocaine, 
with  the  instrument  dehneated  in  Fig.  5,  the  bulb  being 
passed  just  beyond  the  compressor  urethrae  muscle. 

In  many  instances  it  will  be  found  that  the  inflammation 
and  hyperaesthesia  are  finally  reduced  to  a  small  and  prob- 
ably granular,  patch,  which  proves  rebellious  to  the  bougie, 
but  which  usually  disappears  under  the  application  of  as- 
tringent remedies.  Of  these,  I  prefer  a  solution  of  nitrate 
of  silver,  carried  to  the  tender  spot  by  a  contrivance  which 
is  essentially  that  of  Felix  Guyon,^  and  which,  as  is  shown 
in  Fig.  5,  consists  of  a  syringe  of  the  capacity  of  rather  less 
than  a  drachm,  and  of  an  ordinary  bulbous  explorer  per- 
forated at  the  apex  of  the  bulb.     The  syringe  having  been 

^  Gross  on  the  Urinary  Organs,  3d  ed.,  p.  480;  Med.  Record,  June  15,  1878, 
p.  461  ;  and  Trans.  Med.  Soc.  State  of  Penna.,  vol.  xii.  part  i.  p.  67. 
^  Bull.  Gen.  de  Ther.,  1867,  p.  501. 


TREATMENT. 


45 


charo-ed  with  ithe  solution,  and  its  nozzle  attached  to  the 
explorer,  pressure  is  made  upon  the  piston,  until  a  drop  of 
the  fluid^appears  at  the  small  opening.  Wiping  this  off,  the 
oiled  instrument  is  then  carried  down  until  the  bulb  defines 


Fig. 


Syringe  and  perforated  bulbous  explorer. 


the  inflamed  patch — and  it  does  this  with  the  greatest 
accuracy — when  it  is  slightly  withdrawn,  and  a  few  drops 
are  deposited  in  the  urethra.  The  bladder  should  be 
evacuated  before  the  application  of  the  instrument,  and  the 


46 


ATONIC    IMPOTENCE, 


patient  should  be  kept  in  bed  and  use  demulcent  drinks  for 
a  few  hours  subsequently.  With  these  precautions,  the 
pain  and  desire  to  urinate  will  usually  not  last  more  than 

Fic.  7. 


Fig.  6. 


Bulbous  nozzle. 


Dick's  catheter-syringe. 


thirty  minutes,  but  there  will  be  some  scalding  during  the 
next  act  of  micturition.  When  I  first  adopted  this  practice, 
about  sixteen  years  ago,  I  employed  ten  grains  of  the  salt 
to  the  ounce  of  distilled  water,  at  intervals  of  one  week  ; 


TREATMENT. 


47 


but  from  an  extended   experience,   I  now  commonly  use 
thirty  grains,  and  repeat  the  injection  every  four  days. 

As  the  soft,  perforated,  bulbous  explorers  are  not  easily 
procured  in  this  country,  and  as  they  are  liable  to  wear  out, 


Fig.  8. 


Fig.  9. 


Fig.  10. 


S.  D.  Gross's  porte- 
caustique 


Cupped  conical  steel 
bougie. 


Harrison's  porte- 
remede. 


I  have  had  constructed  a  curved;  :hard-rubber  attachment 
for  the   syringe,  which  is   eight  inches   long,  and  which  is 


48  ATONIC    IMPOTENCE. 

provided,  as  is  shown  in  Fig.  6,  with  an  acorn-shaped  head 
or  bulb.  This  instrument  is  not  quite  so  good  in  regard 
to  accuracy  of  definition  of  the  inflamed  patch  as  the  pre- 
ceding one,  but,  with  that  exception,  it  constitutes  the  best 
of  the  contrivances  for  the  purposes  to  which  it  is  adapted. 

In  the  absence  of  the  foregoing  instruments,  Dick's 
catheter-syringe,  Fig.  7,  may  be  employed ;  or  the  cup 
attached  to  the  stylet  of  Gross's  porte-caustique,  Fig.  8, 
may  be  charged  with  five  grains  of  nitrate  of  silver  to  the 
drachm  of  ointment  of  stramonium,  which  I  regard  as  far 
preferable  to  the  fused  salt,  as  the  latter  exerts  a  destructive 
action  on  the  mucous  membrane  unless  the  cauterization  is 
lightly  performed.  The  glycerole  of  tannin,  applied  by 
means  of  a  sound.  Fig.  9,  having  a  cup  at  the  convexity  of 
the  curve,  just  anterior  to  the  shaft,  frequently  answers  a 
good  purpose.  The  depression  filled  with  the  solid  mass  is 
kept  in  contact  with  the  inflamed  patch  for  a  few  minutes, 
or  until  it  is  melted  by  the  heat  of  the  parts ;  but  this  mode 
of  medication  is  open  to  the  objection  that  some  of  the 
liquefied  paste  is  deposited  along  the  whole  length  of  the 
urethra  during-  the  withdrawal  of  the  instrument. 

Another  excellent  mode  of  applying  astringents  is  by 
the  deposition  of  small  soluble  suppositories  of  cocoa  butter 
in  the  affected  portion  of  the  urethra  by  means  of  the 
modified  porte-remede  of  Harrison,  of  Liverpool,  shown  in 
Fig.  10.  The  instrument  consists  of  a  metallic  catheter, 
open  at  the  end  for  the  receptiop  of  the  suppository,  which 
is  so  shaped  as  to  form  a  bulbous  extremity  for  the  instru- 
ment. The  exposed  surface  is  hardened  by  a  layer  of 
spermaceti,  so  as  to  prevent  its  becoming  dissolved  in 
passing  down  the  urethra.  For  ordinary  use  the  supposi- 
tory may  contain  a  quarter  of  a  grain  of  nitrate  of  silver, 
or  two  grains  of  tannin,  or  half  a  grain  of  acetate  of  lead. 


TREATMENT.  49 

When  the  affection  proves  to  be  more  obstinate,  I  have 
found  that  flying  bHsters,  made  by  penciUing  cantharidal 
collodion  first  on  the  one  side  of  the  perineal  raphe,  and, 
after  the  surface  has  healed,  on  the  opposite  side,  are  of 
the  utmost  value.  The  agent  should  be  applied  in  the 
morning,  as  it  is  liable  to  prevent  sleep,  and  great  care 
should  be  taken  to  avoid  vesication  of  the  scrotum  and 
anus. 

Of  general  remedies,  the  aphrodisiacs,  as  cantharides, 
phosphorus,  phosphide  of  zinc,  strychnia,  and  damiana,  are 
to  be  studiously  avoided,  since  the  parts  are  to  be  kept 
still  further  at  rest  by  the  administration  of  agents  which 
diminish  the  reflex  excitability  of  the  cord  and  suspend 
sexual  desires  and  the  power  of  erection.  Of  the  reme- 
dies of  this  class,  bromide  of  potassium  is  by  far  the  best, 
as  it  not  only  blunts  the  venereal  appetite,  but  corrects  the 
acidity  of  the  urine,  and  exerts  an  anaesthetic  influence 
upon  the  mucous  membrane  of  the  urethra.  I  am  in  the 
habit  of  administering  thirty  grains  of  the  salt  every  eight 
hours,  unless  I  find  that  it  makes  the  patient  drowsy  during 
the  day,  when  I  order  a  drachm  to  be  taken  at  bedtime  If 
it  is  not  well  borne,  as  is  indicated  by  physical  and  mental 
languor,  weakness  of  the  heart,  pallor,  uncertain  gait,  acne, 
and  other  signs  of  bromism,  its  use  must  be  discontinued 
for  a  time  ;  or  its  cumulative  action  must  be  prevented  by 
promoting  its  excretion  by  the  urine  by  combining  with  it  a 
diurectic,  as  ten  grains  of  nitrate  or  bitartrate  of  potassium, 
as  recommended  by  Rosenthal  ;'  this  combination  is  far 
better  than  that  with  Fowler's  solution,  which  is  devised  by 
Govvers  and  Bartholow.^  When  the  patient  is  anaemic,  I 
prefer  to  administer  a  drachm  at  night,  and  give  him  three 

'  Wiener  Klinik,  May,  1880,  p.  159. 
^  Materia  Medica  and  Therapeutics,  3d  ed.,  p.  406. 
4 


50  ATONICIMPOTENCE. 

grains  of  quinine  along  with  twenty-five  drops  of  the  tinc- 
ture of  the  chloride  of  iron  three  times  during  the  day. 
My  own  empirical  observations  in  regard  to  the  value  of 
quinine  in  decreasing  the  depression  produced  by  the 
bromides  in  asthenic  subjects  have  been  confirmed  by  Dr. 
Landon  Carter  Gray,'  who  has  shown  that  it  not  only 
increases  the  sedative  effects  of  the  latter,  but  that  it 
diminishes  or  dispels  bromism. 

When  the  patient  is  robust  and  plethoric,  I  frequently 
add  to  each  dose  of  the  bromide  ten  drops  of  the  tincture 
of  veratrum  viride  or  tincture  of  gelsemium  ;  or  the 
bromide  may  be  given  in  half  an  ounce  of  the  infusion  of 
digitalis  ;  and  I  have  every  reason  to  be  pleased  with  the 
action  of  the  combinations.  Instead  of  the  bromide  of 
potassium,  the  monobromide  of  camphor  may  be  employed 
to  the  extent  of  about  twelve  grains  in  the  twenty-four 
hours,  but  its  effects  are  not  so  striking  as  those  of  the 
former  remedy. 

When  the  penis  is  cold  and  rigid,  atropia  is  indicated  to 
overcome  the  contraction  of  the  muscular  fibres  of  the 
trabeculae  of  the  erectile  bodies,  and  to  induce  the  dilata- 
tion of  the  arterioles  and  an  increased  flow  of  blood  through 
the  organ  ;  and  its  good  effects  are  also  evinced  by  the 
diminution  of  the  number  or  the  entire  cessation  of  the 
nocturnal  emissions  and  prostatic  discharges  which  fre- 
quently complicate  the  affection.  One-sixtieth  of  a  grain 
in  solution  should  be  administered  on  risino- ;  and  when  its 
peculiar  action  is  denoted  by  dryness  of  the  mouth,  thirst, 
dilatation  of  the  pupils,  and  slight  confusion  of  vision,  that 
quantity  should  be  taken  on  retiring,  so  that  the  patient 
may  sleep  through  its  disagreeable  effects. 

'  Archives  of  Medicine,  October,  1880,  p.  191. 


TREATMENT.  51 

Of  the  remaining  anaphrodisiacs,  which  have  been 
recommended  in  the  management  of  impotence,  camphor 
and  lupuhne  cannot  be  rehed  upon  ;  while  arsenic  evinces 
its  depressing  action  on  the  sexual  functions  only  when 
administered  in  such  large  doses  as  to  occasion  objection- 
able disorders  of  the  circulatory,  digestive,  and  nervous 
systems. 

Among  the  accessory  measures  I  know  of  "none  that  is 
more  grateful  to  the  patient,  and  more  relaxing  and  soothing 
to  the  irritable  organs,  than  a  sitz-bath  at  a  temperature  of 
about  95°  F.,  taken  for  fifteen  minutes  every  morning  and 
evening.  In  the  absence  of  facilities  for  bathing,  a  sponge 
dipped  in  water  at  a  temperature  of  about  ioo°  F.  may  be 
applied  to  the  perineum  and  the  back.  Cold  baths,  which 
are  recommended  by  many  authors,  are  to  be  studiously 
avoided,  as  they  aggravate  the  local  troubles. 

In  a  large  proportion  of  cases  the  bowels  are  habitually 
constipated.  They  should  be  kept  in  a  soluble  condition, 
particular  attention  being  paid  to  the  rectum.  For  this 
purpose,  tepid  water  may  be  injected  every  morning,  as  it 
has  the  additional  advantage  of  soothing  the  hypersesthetic 
prostatic  urethra.  If  enemata  do  not  answer  the  purpose, 
and  if  there  is  atony  of  the  muscular  coat  of  the  intestines, 
a  pill  composed  of  one-twelfth  of  a  grain  of  aloin,  one-sixth 
of  a  grain  of  extract  of  nux  vomica,  and  one-fourth  of  a 
grain  of  extract  of  hyoscyamus  may  be  administered  after 
each  meal;  or  a  wineglass  of  Hunyadi  or  Friedrichshall 
water,  or  two  drachms  of  equal  parts  of  Epsom  and 
Rochelle  salt,  may  be  ordered  every  morning. 

Any  special  dyspeptic  symptoms  are  to  be  met  by 
appropriate  remedies.  The  diet  should  be  nutritious 
and  digestible,  but  unstimulating;  and  coffee,  malt,  and 
alcoholic    Hquors    must    be    eschewed,   and   the    last  daily 


52  A  T  O  N  I  C     I  M  P  O  T  E  N  C  E , 

meal  should  be  light.  The  patient  should  sleep  on  a  hard 
mattress,  use  only  the  lightest  coverings,  and  empty  his 
bladder  thoroughly  on  retiring,  and  early  in  the  morning  if 
a  more  or  less  complete  erection  indicates  fulness  of  that 
viscus.  He  is,  moreover,  to  be  warned  against  horseback 
exercise  and  driving  over  rough  streets,  and  all  other  forms 
of  amusement  which  tend  to  produce  hyperaemia  of  the 
genitalia,  as*  well  as  against  bodily  and  mental  fatigue  if  the 
signs  of  spinal  and  cerebral  neurasthenia  be  marked. 

Up  to  this  point,  the  treatment,  both  local  and  general, 
has  been  addressed  to  relieving  the  inflammation  and  hy- 
peraesthesia  of  the  prostatic  portion  of  the  urethra.  When 
this  has  been  accomplished,  abundant  observation  has  • 
convinced  me  that  nothing  more,  as  a  rule,  is  required. 
Cases,  however,  do  occur  in  which,  after  the  local  lesions 
have  been  cured,  the  irritability  of  the  genital  centre  is  still 
so  exhausted  that  the  erections  are  not  sufficiently  vigorous, 
and  the  ejaculations  are  premature.  Under  these  circum- 
stances, as  well  as  in  the  rarer  form  of  atonic  impotence, 
in  which  the  prostatic  urethra  is  devoid  of  lesions,  but  in 
which  a  stricture,  if  one  be  present,  will  require  preliminary 
treatment,  the  object  is  to  restore  the  sexual  powers  to 
their  normal  condition  by  remedies  which  tone  up  the  sys- 
tem at  large  and  excite  the  reflex  activity  of  the  genito- 
spinal  centre.  An  excellent  combination  is  twenty-five 
drops  of  the  tincture  of  the  chloride  of  iron,  ten  drops  of 
tincture  of  nux  vomica,  and  two  grains  of  quinia,  to  be 
taken  before  meals  in  a  wiheglassful  of  sweetened  water, 
which  may  be  replaced  by  the  syrup  of  the  phosphate  of 
iron,  quinia,  and  strA^chnia,  in  teaspoonful  doses,  or  by  the 
following  combination,  which  is  probably  more  efficacious 
than  either  of  the  preceding  ones  : 


TREATMENT.  53- 

R. —  Ouinise  sulph., 

Ferri  sulph.,  aa  ^ij  ; 

Zinci  phosphidi,  gr.  ij  ; 

Strychnia  sulph.,  gr.  2^. 
M.— Ft.  pil.  no.  xl. 
S. — Two  pills  every  eight  hours. 

The  fluid  extract  of  damiana,  in  doses  of  from  two  to 
four  drachms  every  eight  hours,  is  said  by  Caldwell,'  of 
Baltimore,  to  be  a  capital  tonic  to  the  nervous  centres 
which  preside  over  erection,  and  his  observations  are  con- 
firmed by  Edwards,^  of  Richmond. 

Among  the  tonic  agents  cold  sitz-baths  and  cold  applica- 
tions to  the  lumbar  regfion  for  about  ten  minutes  hold  a 
high  position.  At  the  commencement  it  will  be  wise  to 
employ  water  at  a  temperature  of  60°  F.,  and  gradually  to 
lower  the  temperature  until  it  is  finally  reduced  to  46°  F. 
The  efficiency  of  the  remedy  will  be  heightened  by  gently 
projecting  a  stream  of  cold  water  against  the  perineum 
and  back  ;  and  one  of  my  patients  informs  me  that  he  has 
derived  the  best  results  from  douches  of  moderate  volume 
after  emerging  from  a  Turkish  bath.  To  promote  reaction 
and  increase  the  flow  of  blood  to  the  lower  divisions  of  the 
spinal  cord  and  the  genitalia,  the  parts  should  be  briskly 
rubbed  after  they  are  dry  with  a  moderately  coarse  towel 
or  with  a  flesh-brush. 

Cold  may  be  applied  directly  to  the  prostatic  portion  of 
the  urethra  by  means  of  the  cooling  sound  or  psychrophor 
of  Winternitz,^  represented  in  Fig.  11,  which  is  nothing 
more  than  a  double  current  eyeless  catheter  closed  at  its 
beak.  To  the  proximal  extremities  of  this  rubber  tubes 
are  attached,  through  one  of  which  the  fluid  flows  into,  and 

'  Virginia  Med.  Journal,  1879,  P-  444-  ^  Ibid.,  p.  716. 

3  Ziemssen's  Hdbch.  der  AUg.  Ther.,  Bd.  11,  Theil  3,  1881,  p.  238. 


54 


ATONIC     IMPOTENCE. 


Fig.  II. 


through  the  other  out  of,  the  instrument.  The  former,  pro- 
vided with  a  stopcock,  is  connected  with  a  rubber  bag  sus- 
pended  a   few   feet  above  the  patient,  while  the  latter  is 

received  in  an  empty  vessel  placed  at 
the  patient's  feet.  At  the  outset,  the 
temperature  should  be  about  57°  F., 
and  be  gradually  reduced  to  52°  F., 
and  the  sittings  be  lengthened  from 
five  to  ten  minutes.  The  device  has 
been  found  to  be  the  most  beneficial 
when  the  ejaculations  are  too  pre- 
cipitate. 

Galvanism  very  deservedly  enjoys  a 
high  reputation  in  the  treatment  of 
impotence.  Not  only  are  the  electro- 
tonic  effects  of  the  constant  current 
valuable  in  increasing  the  excitability 
of  the  genito-spinal  centre,  but  gal- 
vanization is  far  more  serviceable  in 
restoring  the  tonicity  of  the  arterioles 
of  the  erectile  tissues  of  the  penis, 
and  in  increasingf  the  amount  of  blood 
flowing  in  them,  than  are  the  measures 
to  which  I  have  just  alluded.  Although 
the  dose  of  the  current  cannot  be  ac- 
curately prescribed  by  the  number  of 
elements  of  the  battery,  the  quantity 
generated  by  from  fifteen  to  twenty 
cells  will,  as  a  rule,  be  found  to  answer  the  purpose.  The 
anode,  or  positive  electrode,  which  should  be  of  large  size, 
is  placed  over  the  lumbar  spine,  and  the  cathode  carried 
over  the  gland  and  back  of  the  penis,  the  cords,  testes,  and 
perineum.     The  sittings  at  first  should  be  limited  to  two  or 


I 


Winternitz's  psychrophor. 


TREATMENT.  55 

three  minutes  every  forty-eight  hours  ;  but  they  may  soon 
be  lengthened  to  five  minutes  daily.  In  obstinate  cases, 
particularly  if  they  are  complicated  by  prostatic  or  seminal 
discharges,  an  insulated  catheter  negative  electrode  may 
be  passed  down  to  the  prostatic  urethra,  while  the  anode 
is  applied  to  the  back,  groin,  or  perineum,  or  it  may  be 
replaced  by  the  rectal  reophore.  Great  caution  must, 
however,  be  observed  in  the  employment  of  the  urethral 
electrode,  lest  it  awaken  inflammation  of  the  urethra,  or 
neuralgia  of  the  testis  or  cord,  or  even  induce  suppuration 
of  the  testis,  as  I  have  known  to  happen  in  one  instance 
from  the  use  of  too  strong-  a  current.  In  all  cases  it  will 
be  wise  for  the  operator  to  begin  with  from  three  to  five 
cells,  and  to  test  the  current  by  passing  it  through  his  own 
temples,  and  cautiously  to  increase  the  number  of  elements 
to  fifteen,^  if  pain  is  not  excited.  In  the  third  or  paralytic 
variety  of  the  affection,  or  in  the  other  varieties,  if  galvanism 
does  not  bring  about  the  desired  result,  faradization  of  the 
erector  muscles  of  the  penis  and  the  accelerator  muscle  of 
the  urine  is  frequently  highly  serviceable.  If  this  method 
fails,  the  interrupted  current  may  be  passed  through  one 
reophore  in  the  urethra  to  the  other,  placed  on  the  peri- 
neum and  the  genitalia,  or  inserted  in  the  rectum  ;  while 
some  cases  will  improve  more  rapidly  if  local  faradization 
and  galvanization  of  the  cord  are  employed  on  alternate 
days.  When  the  skin  of  the  penis  is  deficient  in  sensibility, 
the  electrical  brush  is  indicated.  Central  pfalvanization^  and 
general  faradization  are  beneficial  when  the  symptoms  are 
those  of  cerebral  and  spinal  exhaustion. 

In  addition  to  the  foregoing  measures,  a  change  of  air, 

'  Althaus,  Medical  Electricity,  3d  ed.,  p.  671. 

^  Beard  and  Rockwell,  Med.  and  Surg.  Uses  of  Electricity,  3d  ed.,  p.  376. 


56  ATONIC     IMPOTENCE. 

travel,  exercise,  amusement,  sea-bathing,  good  food,  and  a 
glass  of  generous  wine  will  do  much  to  give'  tone  to  the 
parts,  and  the  system  at  large. 

The  end  having  been  accomplished,  it  remains  to  put  the 
patient  on  his  guard  against  marital  excess,  for  unless  he 
practises  moderation  he  is  liable  to  a  relapse.  In  a  large 
proportion  of  cases  the  trouble  is  met  with  in  young  men 
who  are  eneaeed  to  be  married.  Under  these  circum- 
stances  matrimony  should  not  be  delayed,  as  regular  and 
temperate  intercourse  tends  to  promote  sexual  quietude. 
When  marriage  is  not  contemplated,  the  patient  should  lead 
a  continent  life,  and  avoid  all  sources  of  sexual  excitability. 


B.— ATONIC    IMPOTENCE    WITHOUT    HYPERESTHESIA    OF    THE 
PROSTATIC   URETHRA. 

Imperfect  or  deficient  erection  may  arise  independently 
of  any  lesion  of  the  prostatic  portion  of  the  urethra  in 
persons  of  nervous  or  sensitive  temperaments,  a  class  of 
subjects  in  whom  diminished  reflex  excitability  of  the  lumbar 
genital  centre  appears  to  be  induced  before  prostatic  in- 
flammation has  had  time  to  declare  itself  In  the  preceding 
form  of  impotence  the  patients  are,  as  a  rule,  robust  and 
strong,  and  inflammation  and  hyperaesthesia  of  the  deep 
urethra  are  set  up  before  the  functions  of  the  genital  centre 
have  been  much  impaired. 

Of  the  twelve  cases  that  have  come  under  my  notice, 
eight  were  due  to  excessive  masturbation,  two  to  gonor- 
rhoea and  masturbation,  and  two  to  gonorrhoea  alone.  In 
nine  a  stricture  was  detected,  while  three  were  free  from 
that  complication,  and  the  prostatic  portion  of  the  urethra 
was  not  morbidly  sensitive  in  a  single  one.      In  eight  of  the 


PSYCHICAL    IMPOTENCE.  57 

cases  the  erections  were  feeble,  and  the  ejaculations  were 
precipitate  ;  and  in  four  intercourse  was  impossible, 
although  desire  was  retained. 

The  treatment  of  this  variety  of  atonic  impotence  is  the 
same  as  that  directed  for  the  preceding  form  after  the 
hyperaesthesia  has  been  remedied. 


Sect.  III.    Psychical  Impotence, 

Impotence  from  the  restraining  or  inhibitory  control  of 
the  brain  over  the  genito-spinal  centre  is  infinitely  less  com- 
mon than  the  preceding  variety ;  but  that  erection  may  fail 
or  cease  under  the  influence  of  excitement,  depressing  or 
other  emotions,  or  mental  preoccupation,  is  a  fact  with 
which  ever)^  one  is  familiar.  Thus  newly  married  men,  who 
were  previously  potent,  and  had  never  indulged  in  sexual 
or  unnatural  excesses,  are  liable  to  be  troubled  in  this 
way,  the  undue  stimulation  of  the  passions  at  their  first 
efforts  at  coition  having  the  effect  of  causing  the  erection 
to  cease  before  the  act  is  completed,  or  of  rendering  it  so 
feeble  that  penetration  is  impossible,  or  of  precipitating 
emission,  or  of  preventing  erection  altogether.  Grimaud 
de  Caux^  relates  the  case  of  a  mathematician  in  whom 
erection  failed  before  emission,  because  his  thoughts  wan- 
dered toward  the  solution  of  an  abstruse  problem.  Onimus 
and  Legros^  refer  to  a  young  man  who  remained  impotent 

'  Physiologic  de  I'Espece,  p.  341. 

'■^  Traite  d'Electricile  Medicale,  p.  215. 


58  P  S  Y  C  H  I  C  A  L    I  M  P  O  T  E  N  C  E  . 

for  years  after  having  been  surprised  at  the  moment  of 
connection  by  the  husband  ;  and  Roubaud'  met  with  a  man 
who  had  been  unable  to  command  an  erection  during  the 
six  months  following  a  railway  accident  in  which  he  was 
terribly  frightened.  The  death  of  a  beloved  child  or  wife, 
as  in  the  cases  of  Roubaud'  and  Ultzmann,-'  may  occasion 
temporary  impotence  ;  and  the  loss  of  a  large  sum  of 
moneys  or  the  drawing  of  a  prize  in  a  lottery'^  may  bring 
about  the  same  result.  In  other  cases,  the  impotence  is,  in 
regard  to  certain  women,  due  to  indifterence,  repugnance, 
or  a  suspicion  of  inhdelit}". 

Impotence  is  very  frequently  entirely  imaginar}^  or  mental, 
although  it  is  based  upon  existing  lesions.  Thus  too  small 
a  penis,  occasional  nocturnal  seminal  losses,  stricture  of 
the  urethra,  a  tight  prepuce,  varicocele,  a  gleety  discharge, 
or  irritability  or  neuralgia  of  the  testis,  not  infrequently  re- 
strain erection  through  fear  of  inability  to  penetrate,  or  of 
increasing  the  pollutions,  or  of  impossibility  of  ejaculating, 
or  of  aggravating  the  local  troubles.  The  same  statement 
is  true  of  moderate  masturbators,  who  probably  have  nor- 
mal nocturnal  emissions  which  they  assume  to  be  or  have 
been  informed  are  indicative  of  a  diseased  condition,  and 
who  seem  to  regard  impotence  as  a  heritage  of  their  vice. 
In  not  one  of  these  conditions  is  there  any  valid  reason  for 
the  trouble,  but  it  has  been  ignorantly  brought  on  by  the 
constant  thought  that  impotence  was  the  natural  result  of 
the  supposed  infirmities. 

I  have  alreadv  alluded  to  the  fact  that  vounsf  husbands, 
in  their  eagerness  to  consummate  the  rite,  not  infrequently 


^  Traite  de  I'lmpuissance  et  de  la  Sterilite,  t.  i.  p.  iS6. 

^  Op.  cit.,  p.  433. 

^  Wiener  Klinik,  May  and  June,  1879,  p.  131. 

*  Ibid.  ^  Roubaud,  op.  rit.,  p.  186. 


ETIOLOGY.  59 

fail ;  and  I  fancy  that  there  are  few  men  who  did  not  ejacu- 
late prematurely  when  they  had  connection  for  the  first 
time.  In  such  cases,  the  repetition  of  the  act  soon  corrects 
the  trouble.  Most  writers  on  impotence,  however,  teach 
that  it  is  not  uncommon  for  newly  married  men  to  be 
baffled,  simply  because  they  are  afraid  that  they  cannot 
accomplish  the  act  properly,  or  because  the  mortification 
which  results  from  the  unfortunate  attempt  gives  rise  to  so 
much  distress  and  anxiety  in  regard  to  its  recurrence  that 
the  otherwise  healthy  subjects  are  really  rendered  impotent. 
I  am  no  believer  in  this  doctrine,  which  is,  as  a  rule,  as  false 
in  fact  as  it  is  pernicious  in  regard  to  the  treatment  which 
such  cases  demand  ;  but  I  do  believe  that  this  condition 
arises  from  overlooked  lesions  of  the  prostatic  urethra  which 
were  induced,  as  a  rule,  by  masturbation.  An  examination 
of  the  views  of  writers  on  this  subject,  as,  for  example,  \'an 
Buren  and  Keyes,'  Curschmann,^  Rosenthal, -^  and  Ultz- 
mann,"*  will  show  that  nervous  or  psychical  impotence  is 
usually  met  with  in  masturbators,  subjects  who  are  always 
more  or  less  timid  as  to  their  virile  powers,  and  many  of 
whom  are  incapable  of  normal  sexual  excitement.  Instead 
of  accepting  the  statements  of  these  patients,  that  their 
failure  was  due  to  normal  impetuosit)',  timidity,  or  want  of 
self-confidence,  it  will  be  wise  for  the  surgeon  to  explore 
the  urethra,  since,  as  I  have  already  indicated,  onanism  is 
the  most  fruitful  source  of  inflammation  and  hypersesthesia 
of  the  prostatic  portion  of  the  urethra,  a  view  in  which  I 
am  sustained  by  Rosenthal,  Ultzmann,   Black,-  Acton, '^  and 

'  Genito-Urinary  Diseases,  with  Sypliilis,  p.  453. 

■'  Ziemssen's  CyclopEedia,  vol.  viii.  p.  892. 

^  Wiener  Klinik,  IMay,  1880,  p.  137.         *  Ibid.,  May  and  June,  1879,  P-  I3°- 

^  On  the  Functional  Diseases  of  the  Renal,  Urinary,  and  Reproductive 
Organs.     Philada.,  1S72,  pp.  229  and  269. 

®  The  Functions  and  Disorders  of  the  Reproductive  Oreans.  2d  Amer. 
ed.,  pp.  91  and  240. 


60  PSYCHICAL    IMPOTENCE. 

nearly  all  surgical  authors.  Hence,  the  failure  to  copulate 
in  this  class  of  patients  is  due  to  diminished  reflex  irrita- 
bility of  the  centre  for  erection,  although  it  is  possible  that 
undue  excitement  or  timidity  may  aggravate  that  condition 
by  exerting  an  inhibitory  influence  over  the  centre.  Such 
cases  should,  therefore,  be  relegated  to  the  preceding  or 
atonic  variety  of  impotence. 

The  only  cases  of  psychical  impotence  that  I  have  ever 
met  with  are  the  following  : 

Case  XVII.  A  widower,  fifty^-two  years  of  age,  was  engaged  to 
be  married,  and,  despite  the  fact  that  he  had  erections  in  the  pres- 
ence of  the  object  of  his  affection,  he  was  so  fearful  that  he  would 
disgrace  himself  on  the  night  of  his  wedding,  that  he  made  the 
experiment  with  another  woman,  and  utterly  failed.  As  a  conse- 
quence of  this  unfortunate  test,  he  constantly  brooded  over  his 
imaginary  trouble,  for  which  he  sought  my  opinion.  I  found  that 
his  genital  organs  and  prostatic  urethra  were  perfectly  normal,  and 
succeeded  in  obtaining  his  confidence  by  assuring  him  that  I  had 
met  with  many  cases  of  a  similar  nature,  and  that  they  had  always 
yielded  readily  to  teaspoonful  doses  of  fluid  extract  of  damiana 
taken  every  eight  hours  for  three  days  before  marriage.  As  a  re- 
sult of  this  ruse,  he  subsequently  wrote  me  that  the  remedy  had 
acted  like  a  charm. 

Case  XVIII.  A  clerk,  twenty-six  years  of  age,  married  two 
days,  on  consummating  his  matrimonial  engagement,  had  a  feeble 
erection  with  a  precipitate  emission.  He  never  had  gonorrhoea, 
but  masturbated  at  an  early  age,  and,  on  ceasing  the  practice,  was 
troubled  with  nocturnal  pollutions.  The  urethra  and  genital  organs 
were  absolutely  sound,  and  the  difficulty  arose  simply  from  fear 
that  he  could  not  accomplish  the  act  properly. 

The  following  would  have  been  classified  as  cases  of 
psychical  impotence  by  physicians  who  are  not  in  the  habit 
of  exploring  the  urethra  in  this  and  allied  aflections  : 


ETIOLOGY.  61 

Case.  XIX.  A  merchant,  twenty-eight  years  of  age,  stated  that 
he  was  suffering  from  spermatorrhoea,  which  had  so  weakened  his 
powers  that,  on  attempting  intercourse  four  years  previously,  the 
erection  was  so  feeble  that  it  passed  off  before  the  completion  of 
the  act.  He  had  not  renewed  the  effort,  as  he  was  convinced  that 
he  was  permanently  impotent.  I  found  that  the  so-called  sperma- 
torrhoea consisted  in  an  intermittent  discharge  of  prostatic  fluid  at 
stool,  and  in  an  occasional  nocturnal  emission.  A  stricture, 
calibre  25,  was  detected  at  six  inches  from  the  meatus,  the  pros- 
tatic urethra  was  excessively  sensitive,  and  the  man  had  almost 
constant  pain  in  the  back. 

Case  XX.  A  lumberman,  thirty  years  of  age,  consulted  me 
on  account  of  impotence,  which  he  ascribed  to  undue  size  of  his 
penis,  as  he  found  that  on  his  first  connection  intromission  was 
difficult,  and  ejaculation  was  precipitate  and  painful ;  and  that  on 
several  subsequent  efforts  the  erections  did  not  come  up  to  the 
proper  standard.  He  had  abstained  from  intercourse  for  about 
thirty  months,  as  he  was  convinced  that  the  trouble  arose  from  the 
size  of  the  organ,  He  suffered  from  pain  in  the  back,  and  weak- 
ness of  vision,  and  informed  me  that  he  had  masturbated  from  his 
fifteenth  to  his  twenty-seventh  year.  There  was  a  stricture,  calibre 
18,  at  six  inches  and  a  quarter  from  the  meatus,  and  the  prostatic 
urethra  was  morbidly  sensitive. 

Case  XXI.  A  commercial  traveller,  thirty-six  years  of  age, 
complains  that  he  has  been  married  for  four  days,  but  that  he  has 
been  unable  to  consummate  the  rite,  in  consequence  of  the  impos- 
sibility of  intromission  from  insufficient  erections.  He  has  never 
had  gonorrhoea,  nor  did  he  masturbate  much  in  his  youth  ;  but 
during  his  engagement,  which  preceded  his  marriage  by  seven 
months,  his  genitalia  were  kept  in  a  constant  state  of  excitement 
by  fondling  the  object  of  his  affection,  and  he  did  not  have  illicit 
intercourse  to  relieve  his  passions.  The  entire  urethra  was  ex- 
quisitely sensitive  ;  but  there  was  no  evidence  of  a  coarctation. 


62  PSYCHICAL     IMPOTENCE. 

In  the  first  two  of  the  foregoing  cases  an  inexperienced 
observer  might  readily  have  assumed  that  the  trouble  de- 
pended upon  brooding  over  conditions  which  the  patients 
thought  had  prevented  natural  copulation  ;  and  he  might 
have  ascribed  the  failure  of  erections  in  the  third  case  to 
congenital  deficiency,  a  variety  of  impotence  which  is  de- 
scribed by  certain  authors,  when  the  causes  are  inexplicable. 
In  all  of  these  examples,  however,  the  failure  of  the  first 
attempts  was  due  to  debility  of  the  genital  centre,  a  lesion 
of  which  the  men  were  naturally  entirely  ignorant. 

I  have  dwelt  somewhat  at  length  upon  the  erroneous 
diagnosis  which  is  usually  made  in  cases  of  so-called  psy- 
chical or  nervous  impotence,  in  order  that  I  might  call  atten- 
tion prominently  to  the  importance  of  examining  the 
urethra  in  all  examples  of  impotence,  since  the  prognosis 
is  far  more  favorable  when  the  trouble  depends  upon  hyper- 
aesthesia  of  its  prostatic  portion  than  when  that  condition  is 
absent.  Had  this  precaution  been  observed  by  many 
writers  on  the  subject,  they  would  have  been  able  to  give  a 
less  gloomy  account  of  psychical  impotence,  and  have  said 
less  of  the  importance  of  gaining  the  patient's  confidence, 
and  of  the  moral  treatment  adapted  to  each  case. 

Treatment. — In  the  management  of  psychical  impotence 
from  undue  sexual  excitement  or  emotional  causes,  little 
need  be  done,  except  to  administer  a  placebo,  with  the 
assurance  that  it  will  afford  relief,  since  such  cases  usually 
remedy  themselves.  In  the  case  of  Grimaud  de  Caux,  the 
wife  resorted  to  the  strategem  of  slightly  intoxicating  the 
husband  before  connection,  through  which  he  was  rendered 
capable  of  procreating. 

In  the  variety  of  mental  impotence  in  which  an  existing 
lesion  has  thoroughly  impressed  the  patient  with  the  belief 


SYMPTOMATIC    IMPOTENCE.  63 

that  it  is  the  source  of  his  trouble,  the  treatment  usually 
advised,  namely,  to  gain  the  man's  confidence,  is  not  easily 
carried  out.  Such  patients  are  very  watchful  of  themselves 
and  of  their  physicians,  and  it  is  useless  to  try  to  convince 
them  that  a  varicocele,  for  example,  is  productive  of  no 
harm,  so  far  as  the  sexual  functions  are  concerned,  or  that 
the  involuntary  emissions  are  strictly  within  the  limits  of 
health.  Hence,  it  is  far  better  to  agree  with  them  that 
their  imaginary  infirmities  demand  treatment,  to  assure  them 
that  they  are  capable  of  relief,  and  above  all  to  institute  the 
treatment  laid  down  in  surgical  works,  as  it  will  be  found 
that  they  are  more  or  less  familiar  with  the  various  maladies 
of  which  they  complain.  A  tight  or  redundant  prepuce 
should,  therefore,  be  removed,  and  the  introduction  of 
bougies,  or  local  galvanization  or  faradization,  or  other 
measures  be  resorted  to,  along  with  a  bitter  tonic,  and  a 
systematic  regulation  of  the  diet,  bathing,  and  exercise. 
The  mind  is  open  to  persuasion  in  this  way,  but  not  by 
mere  assurances,  or  by  making  light  of  the  fancied  dis- 
order. If  the  subject  is  contemplating  matrimony,  he  should 
be  advised  to  fulfil  his  engagement ;  and  a  placebo,  such  as 
a  minute  quantity  of  phosphorus,  or  a  drachm  of  the  tinc- 
ture of  damiana,  of  the  presumed  virtues  of  which  he  will 
have  some  knowledge,  should  be  administered  at  stated 
intervals  for  a  few  days  previously. 


Sect.  IV.   Symptomatic  Impotence. 

Sexual  power  is  now  and  then  greatly  impaired,  if  not 
absolutely  destroyed,  by  the  prolonged  use  of  certain  cere- 
bral   sedatives,    as    opium,    morphia,    chloral,    bromide    of 


64  SYMPTOMATIC    IMPOTENCE. 

potassium,  and  alcohol,  as  well  as  of  cerebral  excitants,  as 
cannabis  indica,  and  by  the  administration  of  or  exposure 
to  arsenic,  antimony,  lead,  sulphide  of  carbon,  and  iodine. 
All  of  these  agents  are  capable  of  exerting  a  harmful  influ- 
ence upon  the  entire  organism,  but  particularly  upon  the 
nervous  system  and  the  genital  organs,  when  pushed  to  an 
undue  extent. 

The  anaphrodisiac  action  of  chloral,  of  bromide  of  potas- 
sium, and  of  spirituous  and  malt  liquors  is  too  well  known 
to  require  illustration.  Rosenthal'  has  recorded  two  cases 
of  impotence  and  azoospermism  from  the  hypodermic  in- 
jection of  several  grains  of  morphia  daily  ;  and  Siredey^ 
states  that  the  habitual  use  of  hashish  by  the  Orientals  in- 
duces absolute  impotence  early  in  life.  Biett,^  Charcot,'^ 
Rosenthal.^  Rayer,^  and  Lewin''  have  observed  that  sexual 
vigor  diminishes  and  finally  ceases  with  the  increase  of  the 
dose  of  arsenic  in  the  treatment  of  diseases  of  the  skin ; 
and  Rosenthal  observed  the  same  effect  in  a  merchant  who 
resided  in  a  room  covered  with  arsenical  paper.  Lohmerer' 
witnessed  impotence  in  four  men  who  were  exposed  to  the 
fumes  of  antimony  ;  and  the  absorption  of  the  vapor  of 
sulphide  of  carbon  by  workmen  engaged  in  the  manufacture 
of  vulcanized  caoutchouc  is  said  by  Delpech'°  to  be  followed 
by  loss  of  virility.  Lead  poisoning  may  cause  temporary 
impotence,  as  in  the  cases  recorded  by  Siredey,"  Portal,'^ 
Roubaud,'3  and  Rosenthal  ;"^    and  Bartholow'^  thinks  that 

1  Wiener  Klinik,  May,  1880,  p.  149. 

^  Diet,  de  Med.  et  de  Chir.  Prat.,  t.  xviii.  p.  456.  ^  Ibid. 

*  Bull,  de  Ther.,  Jan.  1864,  p.  529.  '"  Loc.  cit.,  p.  151. 

^  Ibid.  ^  Berl.  klin.  Wochenschrift,  No.  17,  1884,  p.  268. 

^  Ibid.,  p.  152.  9  Orfila,  Traite  de  Toxicologic,  t.  i.  p.  650. 

1"  Diet,  de  Med.  et  de  Chir.  Prat.,  t.  xviii.  p.  456. 

'^  Ibid.,  p.  455.  12  Cours  d'Anat.  Med.,  t.  v.  p.  434. 

'^  Op.  eit.,  p.  303.  '*  Loe.  cit.,  p.  153. 

^^  Materia  Medica  and  Therapeutics,  3d  ed.,  p.  189. 


PROGNOSIS    AND    TREATMENT.  65 

the  prolong-ed  use  of  the  iodides  has  resulted  in  permanent 
loss  of  the  sexual  power. 

Impotence  is  not  an  uncommon  secondary  effect  of  inju- 
ries of  the  brain  and  spinal  cord  ;  and  it  may  also  be  symp- 
tomatic of  various  functional  disorders  and  of  acute  and 
chronic  affections,  but  particularly  of  the  nervous,  digestive, 
and  urinary  systems,  as  brain  worry,  spinal  irritation  and 
weakness,  spinal  meningitis  and  myelitis,  locomotor  ataxia, 
progressive  muscular  atrophy,  dyspepsia,  saccharine  dia- 
betes, and  albuminuria.  I  have  myself  met  with  a  case  in 
a  young  man  in  which  failure  of  erections  was  one  of  the 
earliest  signs  of  diabetes,  although  the  quantity  of  sugar  in 
the  urine  was  small,  and  the  general  powers  of  the  system 
were  not  reduced.  The  grade  of  impotence  in  that  affec- 
tion, as  Seegen'  has  demonstrated,  is  not  dependent  upon 
the  amount  of  sugar  excreted,  as  virility  may  not  be  im- 
paired when  the  quantity  is  large. 

In  the  preceding  affections,  the  form  of  impotence  gener- 
ally met  with  is  the  so-called  irritable  weakness,  or  the 
condition  characterized  by  feeble  erections  and  hasty  ejacu- 
lations, which  is  soon  followed  by  complete  loss  of  erections 
with  abolition  of  the  sexual  appetite. 

Prognosis  and  Treatment. — When  impotence  arises 
from  the  excessive  use  of  remedial  agents,  from  saturation 
of  the  system  with  arsenic,  lead,  or  other  toxic  substances, 
and  from  certain  chronic  disorders,  the  power  of  erection 
usually  returns  with  the  improvement  in  the  sj^mptoms  ; 
but  when  it  depends  upon  injuries  of  the  cerebro-spinal 
axis  the  outlook  is  unfavorable.  When  all  signs  of  inflam- 
mation  have  subsided  after  disease  or  injury  of  the  cord, 

^  Der  Diabetes  Mellitus,  p.  112. 
5 


66  ORGANIC    IMPOTENCE. 

and,  in  other  cases,  if  the  erections  are  insufficient  after 
the  cure  of  the  original  trouble,  tonics,  with  a  few  drops  of 
tincture  of  cantharides,  or  minute  doses  of  phosphide  of 
zinc,  along  with  cold  douches  and  galvanization  of  the 
spinal  cord  and  testes,  are  indicated. 


Sect.  V.  Organic  Impotence. 

The  power  of  sexual  intercourse  may  be  temporarily  or 
permanently  abolished  in  consequence  of  certain  congenital 
or  acquired  malformations,  injuries,  or  diseases  of  the  ex- 
ternal genital  organs,  through  which  penetration  is  rendered 
impossible,  or  in  which  the  loss  of  erection  depends  upon 
arrested  secretory  activity  of  the  testes. 

A.— i:\IPOTENCE    FROM   ABNORMAL   CONDITIONS   OF    THE    PENIS. 

«•  The  malformations  of  the  penis  which  prevent  coition 
are  complete  absence,  a  rudimentary  condition,  or  division 
of  the  organ,  of  which  vices  of  conformation,  examples 
have  been  recorded,  respectively,  by  Goschler,'  Fodere,^  and 
Forster,^  A  double  penis,  as  in  the  case  observed  by  Van 
Buren  and  Keyes,'*  may  prevent  intromission  ;  but  in  the 
Portuguese,  nineteen  years  of  age,  of  whom  Hart^  gives  a 
full  account,  there  was  considerable  virile  power,  and  the 
left  organ  was  used  in  coition. 

*  Prajer  Vierteljahrschrift,  1859,  ^^-  ^''-  P-  89. 
2  Medecine  Legale,  t.  i.  p.  360. 

^  Klebs,  Hdbch.  der  Path.  Anat.,  p.  1132.  *  Op.  cit.,  p.  5. 

*  Lancet,  1865,  vol.  ii.  p.  124. 


ETIOLOGY. 


67 


^-  Variatio7ts  in  the  size  of  the  penis  are  causes  of  rela- 
tive impotence.  In  the  case  of  Roubaud,'  in  which  the  organ 
was  only  two  inches  long  and  of  the  circumference  of  the 
quill  of  the  porcupine,  its  volume  was  increased  and  inter- 
course rendered  practicable  by  a  mechanical  contrivance  ; 
while  in  the  case  of  Wilson,^  in  which,  at  the  age  of  twenty- 
six,  the  penis  and  testes  were  scarcely  larger  than  those  of 
a  boy  of  eight  years,  the  organs  acquired  the  usual  size  in 
twenty-four  months  after  marriage.  Nothing  can  be  done 
for  the  stunted  penis  which  is  associated  with  exstrophy  of 
the  bladder.  The  organ  may  also  be  unfitted  for  use  by 
being  partially  or  completely  buried  or  concealed  in  a  large 
scrotal  hernia,  hydrocele,  or  elephantiasis  of  the  scrotum, 
from  which  it  may  be  freed  by  appropriate  operatfons,  or  by 
the  application  of  a  truss  if  the  hernia  be  reducible.  Ex- 
treme size  of  the  penis  may  also  involve  relative  incapacity 
for  intercourse  ;  and  inordinate  bulk  from  elephantiasis  or 
morbid  growths  of  the  prepuce,  gland,  or  body  of  the  organ, 
or  from  urethral  or  preputial  calculi,  may  prevent  penetra- 
tion. In  these  lesions  the  prognosis  is  usually  favorable, 
even  if  the  operations  for  their  relief  necessitate  the  re- 
moval of  the  entire  gland.  Loss  of  the  penis  through 
disease  or  through  design  is  irremediable. 

y-  Adhesion  of  the  penis  to  the  scrotum,  the  penis  palme  of 
the  French  writers,  in  which  the  former  is  tied  down  by  its 
under  surface  to  the  latter,  and  is  frequently  incurvated,  is 
a  rare  cause  of  impotence,  but  is  remediable.  In  the  more 
simple  form  of  the  affection  liberation  of  the  organ  may  be 
effected  by  division  of  the  web  of  skin.  When,  on  the 
other  hand,  the  union  is  more  considerable,  and  the  penis 

^  Op.  cit.,  t.  i.  p.  i6o. 

'  Lectures  on  the  Urinary  and  Genital  Organs,  p.  424. 


ORGANIC     IMPOTENCE. 


is  cur\^ed  downwards,  the  combined  operation  of  Weir'  and 
Bouisson^  holds  forth  excellent  prospects  for  a  good  result, 
and  is  described  by  the  former  surgeon  in  the  following- 
terms  :  "An  incision  was  made  on  each  side  of  the  scrotum 
sufficiently  free  from  the  body  of  the  penis  to  afford  skin 
enough  to  cover  the  under  surface  when  released,  and  the 
flaps  were  dissected  up  to  the  penis.  This  constituted  the 
first  step  of  the  operation.  The  second  consisted  in  sepa- 
rating the  urethra,  with  the  corpus  spongiosum,  from  the 
corpora  cavernosa  as  far  back  as  the  posterior  margin  of 
the  scrotum.  This  required  but  a  few  cuts  of  the  scissors, 
as  the  band  was  only  about  one  inch  and  a  half  long,  and 
produced  no  effect  upon  the  curvature  of  the  penis.  On 
stretching  out  the  curved  organ,  the  septum  between  the 
corpora  cavernosa  could  be  easily  felt  as  a  tense,  thickened 
band,  and  its  division  constituted  the  third  step  in  the 
operation.  It  was  accomplished  by  a  tenotomy  knife,  intro- 
duced, however,  not  so  far  as  described  by  Bouisson,  and 
cutting  freely  the  septum  in  its  lower  part  and  half  way 
between  the  grlans  and  the  scrotum.  Immediatelv  after  this 
section  was  made,  the  curve  was  readily  abolished,  and  the 
deformit}^  thoroughly  overcome.  The  transverse  incision 
made  involved,  however,  the  tissues  of  both  corpora  caver- 
nosa, and  gave  rise  to  persistent  and  troublesome  oozing 
of  blood,  only  arrested  by  a  ligature  placed  around  an  acu- 
pressure needle.  The  skin  flaps  were  then  united  by  a 
suture  on  the  under  surface  of  the  penis,  and  the  gaping 
edges  of  the  scrotal  wound  brought  together  without  ten- 
sion ;  having,  how^ever,  first  secured  the  mucous  membrane 
of  the   urethra  by  fine   sutures   to   the  integument  at  the 

^  New  York  Med.  Journ.,  vol.  xix.  p.  281. 

*  De  I'Hypospadias  et  de  son  Trait.  Chir.,  t.  ii.  p.  536. 


ETIOLOGY.  69 

posterior  angle  of  the  wound,  that  is  to  say,  at  the  junction 
of  the  scrotum  with  the  perineum.  The  penis  was  laid 
against  the  abdomen,  without  need  of  a  retaining  bandage, 
and  cold-water  dressings  were  applied  to  the  parts." 

^-  Distortion  of  the  penis  may  prevent  copulation,  and 
may  be  due  to  congenital  or  acquired  affections  of  the 
corpus  spongiosum  or  the  corpora  cavernosa. 

I.  The  most  common  cause  of  unusual  shape  of  the 
male  organ,  according  to  my  observation,  is  congenital  short- 
ness  of  the  corpus  spongiosum,  which  acts  like  the  string  of 
a  bow,  and  keeps  the  penis  bent  downwards  toward  the 
perineum.  In  a  few  examples  this  is  the  only  deformity ; 
but  in  the  majority  there  is  a  slight  degree  of  hypospadias, 
and  the  gland  is  somewhat  flattened.  I  have  myself  met 
with  impotence  from  this  cause  in  two  instances,  and  have 
seen  at  least  a  dozen  additional  cases  in  the  practice  of 
S.  D.  Gross  and  Joseph  Pancoast. 

For  the  relief  of  this  condition,  the  operation  of  cutting 
a  wedge  out  of  the  corpora  cavernosa,  which  was  devised 
by  Physick'  and  which  has  been  successfully  practised  by 
Gross,  Pancoast,  Furneaux  Jordan,''  of  Birmingham,  and 
myself,  is  attended  with  the  most  gratifying  results.  The 
skin  of  the  dorsum  of  the  penis,  behind  the  gland,  having 
been  pinched  up  and  divided  transversely  by  transfixing  its 
base,  a  V-shaped  portion,  embracing  about  two-thirds  of 
the  thickness  of  the  corpora  cavernosa,  and  of  sufficient 
length  to  remedy  the  deformity,  is  excised  by  carrying  the 
bistoury  first  from  behind  forwards,  and  then  from  before 
backwards,  the  second  incision  being  made  about  a  quarter 

^  Gross's  Surgery,  6th  ed.,  vol.  ii.  p.  834, 
■^  Lancet,  1876,  vol.  i.  p.  169. 


70  ORGANIC    IMPOTENCE. 

of  an  inch  behind  the  head  of  the  penis.  The  arteries,  two 
or  three  in  number,  having  been  secured  by  fine  h'gatures, 
the  edges  of  the  wound  are  approximated  by  three  silver 
sutures,  one  of  which  is  carried  through  the  cut  surfaces  of 
the  septum,  and  the  other  through  the  sides  of  the  tunica 
albuginea,  the  edges  of  the  wound  of  the  skin  being 
brought  together  separately.  The  penis  is  then  supported 
upon  a  splint  and  kept  covered  with  cold  water,  and  the 
stitches  are  removed  in  eight  or  ten  days.  For  some  days 
previous  to  the  operation,  full  doses  of  bromide  of  potas- 
sium should  be  administered,  with  the  view  to  prevent 
erections. 

2.  Vicious  direction  of  the  penis  is  generally  due  to  the 
formation  of  circitinscribed plates  or  hunps  of  indin^ation  i7i 
the  erectile  tissue  and  fibrous  sheath  of  the  corpora  cavernosa, 
an  affection  which  was  first  described  by  La  Peyronie,'  and 
subsequently  by  Boyer,^  Kirby,^  Johnson, "^  Galligo,^  Cru- 
veilhier,^  S.  D.  Gross, ^  Hewett,^  Van  Buren  and  Keyes,^ 
Curling,"  Scholz,"  and  other  observers.  The  areas  of  in- 
duration are  usually  single,  and  confined  to  one  of  the 
cylinders,  although,  as  in  several  examples  recorded  by  Kirby 
and  Galligo,  they  may  be  multiple,  and  be  scattered  through- 
out the  organ  ;  and,  as  in  a  case  observed  by  Curling,  they 
may  be  associated  with  a  similar  lesion  of  the  corpus  spon- 
giosum.    Their   consistence   varies,  but   it  is   usually  hard 

^  Mem.  de  I'Acad.  Roy.  de  Chir.,  1S19,  t.  i.  p.  316. 
^  Traiie  des  M.il.  Chir.,  t.  vi.  p.  802. 
^  Dublm  Med.  Press,  Oct.  3,  1849,  p.  209. 
*  London  LTncet,  1851.  vol.  ii.  p.  481. 
^  Gaz.  Med.  de  Paris,  1852,  p.  440. 
^  Anat.  Path.,  t.  iii.  p.  593. 
^  Op.  cit.,  vol.  ii.  pp.  833  and  858. 
^  Ijritish  Med.  Journ.,  Feb.  1872, 

^  New  York  Med.  Journ.,  vol.  xix.  p.  390,  and  op.  cit.,  p.  24. 
'"  Op.  cit.,  p.  462.  '1  Schmidi's  Jahrb.,  Bd.  cii.  p.  33. 


ETIOLOGY. 


71 


and  cartilaginous.  As  the  natural  result  of  the  obliteration 
of  the  meshes  of  the  erectile  tissue,  the  organ,  during  erec- 
tion, deviates  toward  the  lesion,  so  that  it  may  be  drawn 
upwards,  downwards,  or  to  either  side,  thereby  materially 
interfering  with  coidon,  if  not  rendering  that  act  impracti- 
cable. In  one  case  reported  by  Van  Buren  and  Keyes,  the 
penis  curved  almost  to  a  right  angle,  and  in  others  it 
assumed  a  spiral  form. 

The  affection  is  almost  always  met  with  after  middle  life, 
but  its  etiology  is  obscure.  Of  twenty-five  examples  which 
I  have  coHated,  in  ten  the  cause  could  not  be  determined  ; 
in  seven  it  was  connected  with  the  gouty  diathesis  ;  in  four 
it  resulted  from  injury  during  coition  ;  in  three  it  was 
ascribed  to  gonorrhoea  ;  and  in  one  it  arose  from  a  violent 
erection.  Kirby,  Curling,  and  Hewett  believe  that  it  is 
connected  with  gout ;  S.  D.  Gross  has  met  with  it  most 
frequently  in  men  who  have  committed  venereal  excesses  ; 
VerneuiP  states  that  sugar  was  present  in  the  urine  in  nine 
of  the  ten  cases  that  he  had  met  with  ;  while  others  think 
that  it  usually  arises  from  extension  of  gonorrhceal  inflam- 
mation. 

Of  the  intimate  nature  of  the  lesion,  nothing  is  accu- 
rately known,  as  the  condition  has  not  been  verified  by 
post-mortem  inspection.  Hewett  supposes  that  the  nodules 
arise  from  clots  of  blood  in  the  meshes  of  the  corpora 
cavernosa  ;  Van  Buren  and  Keyes  think  that  they  depend 
essentially  upon  chronic  Inflammator}^  plastic  obliteration  of 
the  meshes  ;  and  Klebs^  teaches  that  they  are  the  result  of 
a  combination  of  inflammation  and  thrombosis. 


^  Revue  de  Chirurgie,  No.  12,  1884,  p.  986. 
*  Hdbch.  der  Path.  Anat.,  p.  11 52. 


72  ORGANIC     IMPOTENCE. 

£•  Closely  allied  to  the  preceding  affection  is  cicatricial 
induration  of  the  corpora  cavernosa,  the  effect  of  injury, 
abscess,  or  destructive  inflammation.  Thus,  Curschmann' 
relates  a  case  of  upward  and  lateral  deviation  of  the  penis 
from  an  induration  resulting  from  forcing  the  erect  penis 
downwards.  Baudens'  records  an  example  of  gunshot 
wound  of  one  corpus  cavernosum,  with  lateral  curvature. 
Johnson^  met  with  an  instance  of  distortion  from  abscess  of 
the  right  corpus  cavernosum  ;  and  he  also  describes  a  case 
in  which  the  glans  penis  came  in  contact  with  the  left  side 
of  the  pubes  from  burrowing  phagedaena. 

^-  Giunmata  of  the  corpora  cavernosa,  of  which  condition 
Ricord'^  has  given  a  good  description,  are  not  infrequently 
attended  with  faulty  curvature  of  the  penis  ;  but,  as  they 
do  not  evince  any  tendency  to  break  down,  they  are  indis- 
tinguishable from  the  patches  of  induration  resulting  from 
other  causes. 

'n-  Calcification  of  the  septnin  pectiniforme,  or  the  corpora 
cavernosa,  may  give  rise  to  impotence  from  upward  or 
downward  curvature  of  the  penis.  In  the  case  of  a  man, 
fifty-two  years  of  age,  McClellan^  relieved  the  deformity  by 
removing  a  so-called  ossified  septum  by  an  incision  which 
extended  throughout  the  entire  length  of  the  organ  ;  and 
Regnoli^  also  restored  the  power  of  normal  erection  by 
excising  the  ossified  portion,  which  did  not  include  the 
entire  thickness  of  the  cylinders. 

1  Loc.  cit.,  p.  886. 

Clinique  des  Plaies  d'Armes  a  Feu,  p.  408. 
^  Loc.  cit.,  p.  574. 

*  Bumsteadand  Taylor,  Venereal  Diseases,  4th  ed.,  p.  639. 
^  Lancet,  1828,  vol.  i.  p.  714. 
^  Petrequin,  Brit,  and  For.  Med.  Rev,,  vol.xx.  p.  136. 


ETIOLOGY.  73 

When  distortion  of  the  penis  arises  from  gummata,  the 
prospect  of  rehef  from  the  administration  of  iodide  of 
potassium  and  bichloride  of  mercury,  and  from  friction 
with  mercurial  ointment,  is  favorable.  The  induration 
resulting  from  laceration,  or  so-called  fracture,  oi  the 
corpora  cavernosa  is  irremediable.  The  prognosis  in 
circumscribed  patches  of  these  bodies  is  notoriously  un- 
favorable, as  the  only  cure  from  general  measures,  of  which 
I  have  any  knowledge,  is  that  obtained  by  Scholz  by  the 
application  of  tincture  of  iodine,  plaster  of  vigo,  and  warm 
douches  ;  althougfh  Curling-'  records  a  case  in  which  the 
hardness  nearly  disappeared,  and  in  which  the  erections 
were  almost  normal,  by  the  internal  administration  of  bin- 
iodide  of  mercury,  and  by  the  local  use  of  tincture  of 
iodine.  In  a  case  narrated  by  Friedberg,^  an  induration 
of  the  corpus  cavernosum  as  large  as  a  hazelnut  was  made 
to  disappear  by  inserting  a  seton  under  the  skin,  and  per- 
mitting- it  to  remain  in  contact  with  the  tunica  albuginea 
for  one  month.  Boyer  and  S.  D.  Gross  recommend  ex- 
cision of  the  patches,  a  practice  which  I  myself  would  follow 
if  they  Avere  single,  and  of  moderate  volume.  When  the 
curvature  depends  upon  calcification  of  the  corpora  caver- 
nosa or  its  septum,  the  outlook  is  far  better,  since  the 
removal  of  the  offending  substance,  as  in  cases  of  McClellan 
and  Regnoli,  is  followed  by  the  most  gratifying  results. 
After  a  shot  wound  of  the  right  corpus  cavernosum,  which 
terminated  in  a  hard,  depressed,  and  adherent  cicatrix, 
Baudens  succeeded  in  effecting  a  cure  by  making  two 
incisions  in  the  opposite  cylinder,  on  a  level  with  the 
upper  and  lower  extremities  of  the  scar,  and  exciting 
suppuration    by    the    insertion    of    tents,    through    which 

^  Op.  cit.,  p.  464.  2  Prajer  Vierteljahrschrift,  1862,  Bd.  1.  p.  20. 


74  ORGANIC     IMPOTENCE. 

manoeuvre    a    compensating     induration     was     obtained, 

and  the  curvature  was  remedied. 

e.  The  power  of  erection  may  be  lost  in  consequence  of 
the  permanent  retention  of  a  ball  in  the  corpus  cavernosiini, 
of  which  curious  condition  I  have  recorded  an  example.' 
The  missile  was  encysted  in  the  right  cylinder,  and  its 
point  presented  toward  the  pubes,  from  which  it  was 
separated  about  one  inch  ;  but  the  man  refused  to  have  it 
removed. 

I.  Impotence  may  depend  upon  congenital  or  acquired 
shortness  of  the  frenuin,  through  which  the  head  of  the 
penis  is  distorted ;  and  coition  is  abstained  from  on 
account  of  the  suffering  with  which  the  act  is  attended. 
The  proper  remedy  is  division. 

X.  Finally,  insufficient  erections  are  occasioned  by  varix 
of  the  dorsal  vein  of  the  penis.  In  a  case  of  this  descrip- 
tion, Parona^  effected  a  rapid  cure  by  the  intravenous 
injection  of  equal  parts  of  chloral  and  water;  and  Bar- 
tholow^  states  that  he  has  obtained  excellent  results  from 
the  hypodermatic  injection  of  ergotine  in  the  immediate 
vicinity  of  the  enlarged  and  tortuous  vein. 


B.— IMTOTENXE  FROM  DEFECTS  AND  DISEASE  OF  THE  TESTES. 

o^-  Congenital  bilateral  anorchidism,  or  absence  of  the 
testes,  of  which  condition  examples  are  quoted  in  the 
chapter  on  sterility,  is  necessarily  attended  with  absolute 

'  Med.  and  Surg.  History  of  the  War  of  the  Rebellion,  Part  II.,  vol.  ii. 

P-  345- 

''■  Annales  de  Derm,  et  de  la  Syph,,  t.  i.  p.  453. 
'  Op.  cit.,  p.  295. 


ETIOLOGY.  (O 

impotence.  Cryptorchids,  or  persons  in  whom  the  organs 
are  retained  in  the  abdomen  or  the  groins,  are  on  the 
other  hand  generally  potent,  although  they  are  only  excep- 
tionally fertile ;  and  arrest  of  development,  as  a  rule, 
diminishes  virility. 

/?•  Loss  of  the  testes  from  disease,  self-mutilation,  or  sur- 
gical interference  is  presumptive  of  inability  to  copulate, 
although  in  exceptional  cases  the  erections  may  continue 
for  a  considerable  time,  as  is  exemplified  in  the  following 
instances. 

Sir  Astley  Cooper  removed  the  testis  of  a  man  two  years 
after  the  other  had  been  excised.  For  the  first  twelve 
months  he  had  connections.  At  the  end  of  two  years  the 
erections  were  more  rare  and  imperfect,  and  they  usually 
ceased  under  attempts  at  congress.  Ten  years  subse- 
quently he  stated  that  he  had  had  intercourse  only  once 
during  the  previous  year  ;  and  twenty-eight  years  after  the 
operation  the  penis  was  shrivelled  and  wasted,  and  for 
many  years  coition  had  been  impossible. 

M.  Wilson'  removed  both  testes  for  malignant  disease, 
and  the  man  survived  the  operation  two  years.  He  had 
occasional  erections,  and  intercourse  was  attended  with  the 
usual  feeling  and  with  the  ejaculation  of  some  fluid. 

Professor  Humphry'  met  with  a  man  who  had  submitted 
to  castration  on  account  of  nervous  troubles,  but  who  was 
able  to  have  connection  with  an  emission  for  more  than  a 
year,  although  less  frequently  than  before  the  mutilation. 

Mr.  Curling^  removed  the  right  testis  of  an  officer  seven 
years  after  the  excision  of  the  left  testis  by  another  sur- 

^  Lectures  on  the  Urinary  and  Genital  Organs,  p.  133. 
^  Holmes's  System  of  Surgery,  2d  ed.,  vol.  v.  p.  160. 
*  Op.  cit.,  4th  ed.,  pp.  307  and  450. 


*  ■ 

76  ORGANIC     IMPOTENCE. 

geon.  At  the  expiration  of  four  years  and  a  half  from  the 
operation  the  officer  informed  Mr.  CurHng  that  he  had  in- 
tercourse with  his  wife  about  once  a  fortnight,  but  without 
an  ejaculation. 

}'.  Progressive  atrophy  of  the  testes  is  very  liable  to  be 
attended  with  impotence ;  and  Liegeois'.  found  that  the 
power  of  erection  was  diminished  in  four  cases  out  of  six 
of  atrophy  of  one  organ. 

^'  Bilateral  syphilitic  orchitis  generally  involves  impo- 
tence f  while  of  forty-one  examples  of  double  epididymitis 
analyzed  by  Liegeois^  and  Gosselin*  virility  was  diminished 
in  only  eight. 

f-  Tiuiiors,  as  carcinoma,  and  sarcoma,  and  tiibercle,  when 
they  completely  destroy  or  disorganize  the  parenchyma  of 
the  testes,  are  also  attended  with  impotence  ;  but  the  state- 
ment does  not  hold  good  when  one  organ  alone  is  affected. 

The  power  of  erection  after  having  been  lost  may  usually 
be  restored,  when  it  depends  upon  syphilitic  orchitis,  by 
mercurial  inunctions  and  the  exhibition  of  iodide  of  potas- 
sium and  bichloride  of  mercury.  Arrest  of  development  of 
the  testes  is  sometimes  overcome  by  the  influence  of  sexual 
desires,  as  in  the  interesting  example  recorded  by  Wilson,^ 
in  which,  at  the  age  of  twenty-six,  the  glands  were  not 
larger  than  those  of  a  child,  but  in  which  they  increased 
almost  to  the  volume  of  those  of  an  adult  man  two  years 
after  marriage.  In  all  the  remaining  causes  of  impotence 
from  lesions  of  the  testes  the  trouble  is  beyond  relief. 

i  Annales  de  Derm,  et  de  la  Syph.,  t.  i.  p.  437, 

^  Liegeois,  loc.  cit.,  p.  431.  ^  Ibid.,  p.  424. 

*  Archives  Generales,  ser.  5,  t.  ii.  p.  267.  ^  Op.  cit.,  p.  424. 


CHAPTER     II. 

STERILITY. 

Sect.  I.    General  Observations. 

The  generative  act  on  the  part  of  the  male  impHes  the 
completion  of  sexual  congress  with  an  ejaculation  of  fertile 
semen,  and  its  deposition  in  the  upper  part  of  the  vagina. 
As  we  have  already  seen,  the  capacity  for  copulation  de- 
pends upon  the  perfect  erection  of  the  penis,  the  failure  of 
which  renders  the  man  sterile  from  impotence.  Sterility, 
on  the  other  hand,  not  only  does  not  include  impotence, 
but  is  met  with  in  subjects  who  are  vigorous  in  intercourse, 
and  who  ejaculate  a  fluid  which,  in  the  absence  of  minute 
examination,  presents  all  the  properties  of  normal  semen. 
Hence  it  is  dififiicult  for  these  subjects  to  realize  that  they 
are  the  cause  of  barren  marriages. 

For  the  proper  understanding  of  the  alterations  which 
the  semen  undergoes  in  disease,  I  consider  it  requisite  to 
preface  the  consideration  of  sterility  with  a  summary  of  the 
most  important  attributes  of  the  normal  fluid. 

Semen  is  the  mixed  product  of  the  secretions  of  the 
testes,  vasa  deferentia,  seminal  vesicles,  sinus  pocularis, 
prostate,  Cowper's  glands,  and  the  mucous  follicles  of  the 
urethra.  The  thick,  white,  pasty  secretion  of  the  semi- 
niferous tubes  consists  mainly  of  spermatoblasts,  or  seminal 
cells,  out  of  which  the  spermatozoa,  or  fertilizing  elements, 
are  developed ;  but  the  spermatozoa  first  make  their 
appearance  in  the  rete  testis,  and  constitute  at  least  nine- 


78  STERILITY. 

tenths  of  the  glutinous  mass.  In  the  epididymes  and  vasa 
deferentia  the  zoosperms  are  perfectly  motionless  from  the 
density  of  the  medium  in  which  they  are  contained  ;  but 
when  they  have  reached  the  seminal  vesicles  they  are  in 
active  rhythmical,  undulating  motion.  These  facts  are 
noticed  because  some  authors  have  erroneously  based  their 
conclusions  in  regard  to  the  productiveness  of  the  semen 
upon  minute  examination  of  the  parenchyma  of  the  testes 
and  the  epididymes,  or  situations  in  which  spermatozoa  are 
only  forming,  or  in  which  they  have  as  yet  not  acquired 
mobility. 

The  fluid  contained  in  the  seminal  vesicles  is  odorless, 
viscous,  and  colorless,  resembling  fresh  honey,  heavier  than 
water,  of  neutral  reaction,  and  does  not  coagulate.  When, 
however,  it  is  incorporated  with  the  secretions  of  the  pros- 
tatic and  urethral  glands,  semen  has  an  albuminous  con- 
sistence, a  whitish  or  opalescent  tint,  and  an  alkaline 
reaction,  and  it  emits  a  peculiar  faint  odor  which  is  not 
unlike  that  of  the  raspings  of  fresh  horn  or  bone.  After 
ejaculation  it  is  transformed  into  a  gelatinous  mass,  but 
it  becomes  more  fluid  after  exposure  to  the  air  for  a  few 
minutes. 

From  the  preceding  considerations  it  is  obvious  that, 
while  the  testes  furnish  the  fecundating  elements  of  the 
semen,  the  secretions  of  the  associated  glands,  and  par- 
ticularly the  secretion  of  the  prostate,  not  only  render  it 
more  thin  and  abundant,  but  also  impart  to  it  its  color, 
odor,  alkalinity,  and  coagulability.  The  prostatic  fluid, 
moreover,  has  a  more  important  function  than  that  of 
serving  as  a  vehicle  for  the  transmission  of  the  sperma- 
tozoa to  the  uterus,  since   Kraus'  has  shown  that,  in  its 

1  Medical  Times  and  Gaz.,  1871,  vol.  i.  p.  170. 


COMPOSITION    OF    THE    SEMEN.  79 

absence,  these  bodies  cannot  live  in  the  uterine  mucus, 
but  that,  with  its  aid,  they  often  survive  more  than  thirty- 
six  hours,  or  even  for  eight  days  and  a  half  as  has  been 
demonstrated  by  Percy,'  of  New  York, 

As  early  as  1856  Marris  Wilson""  assigned  the  same 
purpose  to  the  secretion  of  the  prostate,  and  regarded  the 
neutral  phosphate  of  lime  contained  in  that  fluid  as  the  ele- 
ment upon  which  the  vitality  of  the  spermatozoa  depends, 
since  it  protects  them  against  destruction  by  the  too  acid 
or  too  alkaline  conditions  of  the  secretions  of  the  passages 
through  which  they  have  to  pass  in  their  progress  to  the 
ovum. 

If  the  ejaculated  semen  be  permitted  to  stand  in  a  test 
tube  for  a  few  hours,  it  will  separate  into  two  layers,  of 
which  the  upper  one,  or  the  liquor  seminis,  is  thin,  whey- 
like, and  transparent,  and  contains  a  few  epithelial  cells 
derived  from  the  seminal  passages  and  detritus,  while  the 
lower  one  is  thick,  white,  opaque,  and  consists  of  sperma- 
tozoa. From  the  thickness  of  the  sediment,  and  the 
rapidity  of  its  precipitation,  Ultzmann^  states  that  a  con- 
clusion may  be  drawn  in  regard  to  the  number  of  sperma- 
tozoa in  any  given  specimen,  as  will  be  pointed  out  in  the 
consideration  of  azoospermism  from  abnormal  conditions 
of  the  semen. 

A  drop  of  semen  discloses  under  the  microscope,  as  in 
Fig.  1 2,  the  male  elements  of  generation,  or  spermatozoa, 
which  are  constituted  by  a  pyriform,  flattened  head,  an 
intermediate  portion,  or  the  beginning  of  the  tail,  and  a 
long,  tapering,  filiform  tail,  which  is  in  rapid  undulating 
motion,   and   which   propels    the    head    directly   forwards. 

^  Sims,  Uterine  Surgery,  p.  374. 

^  Lancet,  1856,  vol.  ii.  p.  483. 

'  Wiener  Klinik,  May  and  June,  1879,  P-  ^53- 


80 


STERILITY. 


These  movements  should  continue  at  least  twelve  hours 
after  the  fluid  is  ejaculated.  If  they  are  wanting,  and  the 
spermatozoa  are  alive,  as  may  happen  when  the  semen  is 


Fig.  12. 


Fig.  13. 


Spermatozoa. 


Spermatic  crystals. 


too  thick,  motion  may  be  excited  by  the  addition  of  weak 
alkaline  solutions  ;  but  if  they  remain  motionless  under  this 
treatment,  they  are  incapable  of  impregnating  the  ovum. 

Minute  examination  of  semen  which  has  been  allowed 
to  dry  on  an  object  glass,  or  of  the  lower  layer  which 
forms  after  the  secretion  has  stood  for  some  time,  shows, 
on  the  second  or  third  day,  at  first  a  few  and  later  a 
considerable  number  of  transparent,  variously  modified 
rhombic  prisms  with  their  bases  in  apposition  ;  the  ends  of 
these  occasionally  terminate  in  fine  points,  but  usually  in 
rhombi,  as  in  Fig.  13.  They  were  discovered  by  Van 
Deen'  and  Boettcher,^  the  latter  of  whom  termed  them 
spermatic  crystals,  and  regarded  them  as  being  composed 


^  Ctrbl.  fiir  die  med.  Wiss.,  1864,  p.  355. 
^  Virchow's  Archiv,  Bd.  xxxii.  p.  535. 


COMPOSITION    OF    THE    SEMEN.  81 

of  albumen.  Ultzmann,  however,  says  that  they  consist  of 
phosphate  of  magnesium,  while  other  observers  regard 
them  as  being  composed  of  ammonio-magnesian  phos- 
phate, a  view  in  which  I  coincide,  and  which  is  verified  by 
Fig.  1 6.  Ultzmann'  has  directed  attention  to  the  fact, 
which  has  been  confirmed  by  Rosenthal's^  and  my  own 
investigations,  that  the  early  and  abundant  formation  of 
these  crystals  denotes  a  diminution  of  the  number  of  the 
spermatozoa  or  their  entire  absence  ;  and  Furbringer,^  from 
an  examination  of  the  contents  of  the  seminal  vesicles  and 
the  prostatic  fluid  of  sixty-six  bodies,  and  of  the  prostatic 
secretion  derived  from  twenty-one  healthy  persons,  has 
demonstrated  that  the  crystals  occur  exclusively  in  the 
latter,  and  that  they  indicate  functional  activity  of  the 
glands  of  the  prostate.  That  this  view  is  correct  is  also 
demonstrated  by  the  early  appearance  of  the  crystals  in 
large  numbers  in  the  fluid  ejaculated  by  azoospermous 
subjects. 

Semen  begins  to  be  secreted  at  the  epoch  of  puberty, 
and  continues  to  be  formed  until  an  advanced  age,  al- 
though the  sexual  power  is  usually  lost  after  the  sixty-fifth 
year.  Liegeois*  examined  the  ejaculated  fluid  of  eight 
young  persons,  and  found  abundant  spermatozoa  in  two 
at  fourteen  years,  in  four  at  sixteen  years,  and  in  two  at 
eighteen  years.  Previous  to  th*e  researches  of  Duplay^  in 
1852,  and  of  Dieu^  in  1867,  the  opinion  was  very  general 
that  the  semen  of  old  persons  was  as  infertile  as  was  that 
of  impubic  boys,  although  Wagner^  has  noted  the  presence 

^  Loc.  cit.,  p.  154.  ^  Wiener  Klinik,  May,  1880,  pp.  137,  139,  and  149. 

*  Volkmann's  Vortrage,  No.  207,  pp.  1848-185 1. 

*  Medical  Times  and  Gazette,  1869,  vol.  ii.  p.  247. 
^  Archives  Generales,  ser.  4,  t.  xxx.  p.  385. 

®  Journ.  de  I'Anat.  et  de  Phys.,  1867,  p,  449. 

^  Histoire  de  la  Generation,  p.  31. 

6 


82  STERILITY. 

of  spermatozoa  in  sexagenarians  and  septenarians,  and 
Curling"'  and  Casper^  had  met  with  them,  respectively,  at 
eighty-seven  and  ninet}^-six  years.  That  old  men  in  the 
enjoyment  of  good  health  are  as  able  to  produce  zoosperms 
as  younger  men  is  shown  by  the  investigations  of  Liegeois,^ 
who  discovered  them  in  every  examination,  thirteen  in 
number,  of  the  fluid  emitted  by  that  class  of  persons. 
When  death,  however,  occurs  from  decrepitude,  or  without 
any  organic  lesions  except  those  which  are  common  to 
advanced  age,  Dieu  found  that  the  fluid  of  the  seminal 
vesicles  contained  spermatozoa  in  only  six,  or  twent)'-three 
per  cent.,  of  twenty-three  examinations.  From  these 
observations  we  may  conclude  that  the  secretion  of  semen 
continues  to  be  formed  in  healthy  old  men,  but  that  it  is 
very  liable  to  cease  in  decrepitude.  These  facts  and  the 
production  of  semen  in  disease  will  receive  full  attention  in 
the  succeeding  section.  . 

Classification. — Sterility  includes,  first,  azoospermism, 
or  the  condition  in  which  either  no  semen  whatsoever,  or 
unproductive  semen,  is  secreted  ;  secondly,  aspermatism, 
in  which  spermatic  fluid  is  not  ejaculated  ;  and,  thirdly,  mis- 
emission,  or  the  failure  to  deposit  fertile  semen  in  the  upper 
portion  of  the  vagina.  In  the  first  variety  intercourse  and 
ejaculation  are  natural,  but  the  essential  anatomical  ele- 
ments are  absent  or  dead,  either  because  they  are  not 
formed  or  are  imprisoned  behind  an  obstacle  seated  in  the 
epididymes  or  vasa  deferentia,  or  because  they  are  unable 
to  live  in  the  medium  in  which  they  are  suspended.  In  the 
second  variety  the  ability  to  copulate  is  unimpaired,  but  the 

^  Op.  cit.,  p.  432.  ^  Forensic  Medicine,  Syd.  Soc.  ed.,  1864,  p,  292. 

^  Loc.  cit.,  p.  247. 


RELATIVE    FREQUENCY.  83 

power  to  ejaculate  is  prevented  by  an  impediment  situated 
between  the  seminal  vesicles  and  the  urinary  meatus.  In 
the  third  variety  coition  and  emission  are  perfect ;  but 
fruitful  semen  fails  to  reach  its  proper  destination,  in  conse- 
quence of  congenital  deficiencies  of  the  urethra,  or  of  fistu- 
lous openings  in  that  canal  resulting  from  inflammation,  or 
of  abnormal  positions  of  the  meatus. 

Relative  Frequency, — It  is  not  at  all  uncommon  for 
physicians  to  assume  that  a  man  who  is  potent,  and  who  is 
able  to  ejaculate,  is  capable  of  procreating.  As  a  result  of 
the  omission  to  examine  the  emitted  fluid,  and  carefully  to 
explore  the  male  organs,  little  is  known  of  the  relative  fre- 
quency of  sterility  in  the  two  sexes  ;  and  gynecologists, 
with  the  exception  of  those  mentioned  below,  do  not  appear 
to  have  made  any  contributions  to  the  solution  of  this  im- 
portant subject.  I  have  been  able  to  collect  one  hundred 
and  ninety-two  cases  in  which  examination  of  both  the 
husband  and  wife  demonstrates  that  the  former  was  at  fault 
in  thirty-three,  or  in  seventeen  per  cent.  Of  this  number, 
Manningham^  records  one  in  thirty;  Pajot'  seven  in  eighty; 
Mondot'  one  in  ten  ;  Kehrer^  fourteen  in  forty ;  Courty^ 
one  in  ten  ;  Noeggerath*  eight  in  fourteen  ;  and  I  myself 
"have  found  that  the  male  was  deficient  in  one  example  in 
eight.  The  cause  of  the  sterility  was  azoospermism  in 
thirty-one,  and  aspermatism  in  two.  These  facts  show  that 
the  husband. is  at  fault  in  about  one  case  out  of  every  six; 
and    they  convey  information  which    should    be    carefully 

1  Wiener  Med.  Blatter,  1879,  PP"  ^223  and  1271. 

^  Beitrage  zur  Klin,  und  E.xper.  Geburtskunde  und  Gynakologie,    Bd.   ii. 
p.  76. 

^  Wiener  med.  Presse,  1880,  p.  252. 

*  Trans.  Amer.  Gynec.  Soc,  vol.  i.  p.  287. 


84  AZOOSPERMISM. 

weighed  before  the  practitioner  even  resorts  to  inspection 
of  the  female  organs  of  generation. 


Sect.  II.    Azoospermism. 

Azoospermism  may  be  due,  first,  to  congenital  bilateral 
anorchidism  ;  secondly,  to  congenital  bilateral  deficiencies 
of  the  epididymis  or  vas  deferens  ;  thirdly,  to  cryptorchid- 
ism ;  fourthly,  to  affections  of  the  testes  ;  fifthly,  to  oblit- 
eration or  obstruction  of  the  epididymes  or  vasa  deferentia  ; 
and  sixthly,  to  abnormal  conditions  of  the  semen.  Hence, 
the  affection  may  be  congenital  or  acquired,  and  absolute 
or  relative. 

A.— BILATERAL  ANORCHIDS. 

Men  born  without  testes  are  not  only  azoospermous, 
but,  from  the  fact  that  the  accessory  secreting  organs  are 
rudimentary,  they  are  unable  to  ejaculate  a  drop  of  any 
kind  of  fluid.  From  a  study  of  four  cases,  Godard'  found 
that  persons  in  this  condition  resemble  eunuchs  mutilated 
early  in  life.  They  have  no  venereal  desire,  and  although 
they  may  have,  as  an  exception,  erections,  they  are  abso- 
lutely impotent  and  sterile.  It  is  important  to  bear  in  mind 
that  a  distinction  may  be  made  between  anorchids  and 
cryptorchids,  when  the  testes  are  retained  in  the  abdomen, 
as  the  latter  are  apt  at  coition,  and  emit  a  fluid  which  is, 
however,  as  a  rule,  devoid  of  spermatozoa. 

^  Note  sur  I'Absence  Congeniale  du  Teslicule.     Memoires   de  la  Soc.  de 
Biologic,  1859,  P-  3^^- 


ABNORMAL    POSITION    OF    TESTES.  85 

B.— CONGENITAL  BILATERAL  DEFICIENCY  OF  THE  EPIDIDYMIS 
AND  YAS  DEFERENS. 

Double  deficiencies  of  the  excretory  apparatus  of  the 
testes  prevent  the  ehmination  of  the  secretion  of  the  latter, 
and  render  them  useless.  Rhodius^  met  with  an  instance 
of  absence  of  the  epididymes  in  an  adult ;  and  John  Hunter^ 
dissected  a  body  in  which,  while  the  testes  were  normal 
and  were  contained  in  the  scrotum,  the  epididymes  and 
vasa  deferentia  were  deficient,  and  the  seminal  vesicles  did 
not  communicate  with  the  urethra.  Although  the  state  of 
the  genital  functions  in  these  cases  must  remain  a  matter 
of  conjecture,  there  is  no  reason  for  believing  that  a  mere 
deficiency  of  the  excretory  passages  between  the  testes  and 
seminal  vesicles  engenders  impotence  and  incapability  of 
ejaculation,  provided  the  seminal  vesicles,  ejaculatory  ducts, 
and  the  prostate  are  normal,  as,  under  these  circumstances, 
the  condition  would  not  be  worse  than  that  of  imprison- 
ment of  the  secretion  of  the  testes  by  acquired  obstruction 
of  the  vasa  deferentia. 


C— FAILURE  OF  THE  TESTES  TO  DESCEND  INTO  THE  SCROTUM. 

When  the  testes  fail  to  descend  into  the  scrotum,  and 
are  retained  in  the  abdomen  or  the  groins,  they  are  gen- 
erally small  and  undeveloped,  and  now  and  then  atrophied 
through  fibrous  or  fatty  degeneration.  As  a  result  of 
these  malpositions  and  morbid  changes,  cryptorchids  were, 
up  to  a  comparatively  recent  date,  declared  to  be  abso- 

^  Quoted  by  Godard  in  his  Note  sur  I'Absence  Congeniale  du  Canal  Ex- 
creteur  et  du  Reservoir  de  la  Semence,  le  Testicule  Existant.     Ibid.,  p.  335. 
^  Works  by  Palmer,  vol.  iv.  p.  23. 


86  AZOOSPERMISM. 

lutely  sterile,  although  they  were  known  to  enjoy  the 
capacity  for  copulation  and  ejaculation.  Opposed  to  this 
opinion,  which  was  maintained  by  Follin,'  Gosselin,^  God- 
ard,3  Liegeois,*  and  formerly  by  Curling,^  are  the  instances 
recorded  by  Poland,^  Cock,^  Durham,^  and  Debrou,^  of 
married  cryptorchids  who  had  procreated  children.  It  is 
highly  probable  that  fecundation  in  these  cases  was  due  to 
another  source,  a  supposition  which  is  strengthened  by  the 
fact  that  spermatozoa  were  not  observed  in  the  patient  of 
Debrou  after  death  from  strangulated  hernia,  and  that  the 
ejaculated  fluid  does  not  appear  to  have  been  minutely 
examined  in  the  others ;  and  there  is  other  evidence  which 
proves  that  the  retained  testes  may  perform  their  func- 
tions. Thus,  BeigeP°  narrates  the  case  of  a  man,  two-and- 
twenty  years  of  age,  whose  testes  were  situated  in  the 
groins,  and  whose  emitted  semen  disclosed  spermatozoa ; 
and  Vallette"  found  those  bodies  in  the  vasa  deferentia  of 
an  inguinal  cryptorchid. 

On  the  whole,  the  evidence  in  regard  to  cryptorchids 
shows  that  while,  as  a  rule,  they  are  potent,  and  ejaculate  a 
fluid  which  is  devoid  of  spermatozoa,  exceptional  instances 
indicate  that  they  may  be  fertile.  This  opinion  is  held  by 
Casper  ;'^  but  the  question  of  fecundity  should  always  be 
determined  by  microscopical  examination  of  the  ejaculated 

^  Archives  Generales,  ser.  4,  t.  vi.  p.  257. 

^  Ibid.,  ser.  4,  t.  ii.  p.  268. 

^  Etudes  sur  la  Monorchidie  et  la  Cryptorchidie,  p.  143. 

*  Medical  Times  and  Gazette,  1869,  vol.  ii.  p.  248. 

^  Brit,  and  For.  Med.-Chir.  Rev.,  April,  1864,  p.  495  et  seq. 

^  Guy's  Hospital  Reports,  ser.  2,  vol.  i.  p.  162. 

''  Curling,  op.  cit.,  4th  ed.,  pp.  470  and  471. 

8  Ibid.  '  Ibid. 

^°  Virchow's  Archiv,  Bd.  xxxviii.  p.  144. 

"  Pitha  und  Billroth's  Handbuch,  Bd.  iii.,  Abth.  ii.,  Lief.  7,  p.  419. 
"  Forensic  Medicine,  Syd.  Soc.  ed.,  1864,  p.  256. 


AFFECTIONS    OF     THE    TESTES.  87 

semen  of  such  persons  when  they  are  contemplating  mat- 
rimony. 

D.— AFFECTIONS  OF  THE  TESTES. 

Disorders  of  the  testes  are  Hable  to  be  accompanied 
with  temporary  or  permanent  absence  of  the  spermatozoa. 
In  six  cases  of  bilateral  atrophy,  Liegeois'^  found  that  these 
bodies  were  greatly  diminished  ;  and  they  are  not  formed 
when  the  wasting  is  excessive.  The  only  instances  in 
which  the  semen  has  been  examined  in  the  latter  condition, 
of  which  I  have  any  knowledge,  are  three  recorded  by 
Curling,^  and  one  by  Laborde  and  Cousrem  ;3  and  sperma- 
tozoa were  absent  in  all.  Simple  parenchymatous  orchitis, 
and  total  disorganization  of  the  substance  of  the  testes, 
from  whatever  cause  they  may  arise,  as  well  as  fatty  de- 
generation of  the  secreting  cells,  a  condition  met  with  in 
hard  drinkers,  are  followed  by  absolute  azoospermism. 
Pardal  destruction  by  malignant,  tubercular,-  cystic,  and 
other  new  formations,  on  the  other  hand,  does  not  neces- 
sarily occasion  sterility.  Syphilitic  orchitis,  when  pro- 
nounced, generally  abolishes  the  functions  of  the  organs, 
but  spermatozoa  may  return  under  proper  treatment  It 
need  scarcely  be  added  that  loss  of  the  testes,  as  from 
castration,  renders  the  subject  permanently  azoospermous, 
although  he  may  for  a  certain  time  ejaculate  the  fluid  of 
the  accessory  glands,  a  phenomenon  which  is  referred  to 
on  page  75. 

Godard^  has  called  attention  to  the  sin  ovular  fact,  which 
he  confirmed  by  examination  of  the  ejaculated  semen  and 

1  Loc.  cit.,  p.  541.  ^  Op.  cit.,  pp.  69  and  83. 

^  Comptes  Rendus  de  la  Socieie  de  Biologic,  1859,  P-  ^4^- 
*  Ante. 


88  AZOOPERMISM. 

of  the  contents  of  the  seminal  vesicles,  that  one  tubercular 
testis  renders  the  subject  absolutely  sterile ;  and,  what  is 
more  astonishing,  he  found  that  the  azoospermism  pre- 
ceded the  development  of  the  tubercular  affection  from 
one  to  two  years.  Hence,  he  utilizes  this  condition  for  the 
differential  diagnosis  between  unilateral  tubercular  orchitis 
and  ordinary  orchitis,  in  the  latter  of  which  fertile  semen  is 
secreted. 


E.— BILATERAL  OBLITERATION  OF  THE  EPIDIDYMIS  AND 
VAS  DEFERENS. 

By  far  the  most  frequent  and  important  of  the  causes  of 
azoospermism  is  bilateral  obliteration  of  the  epididymis 
and  vas  deferens,  through  which  the  proper  secretion  of 
the  testes  is  confined,  and  is  prevented  from  reaching  the 
vesiculae  seminales  and  the  urethra,  and  the  ejaculated 
fluid  is  of  necessity  deprived  of  spermatozoa.  Obliteration 
of  the  seminal  passages,  as  Gosselin'  first  pointed  out, 
is  usually  due  to  gonorrhoea,  when  it  is,  with  few  excep- 
tions, confined  to  the  epididymes,  the  vasa  deferentia  alone 
being  rarely  involved.  I  am  not  aware  that  it  has  ever 
been  traced  to  traumatic  inflammation,  as  wounds  and 
contusions  are  generally  limited  to  one  side.  Tubercular 
deposits  in  the  epididymes  not  uncommonly  occasion 
sterility;  and  a  few  examples  are  recorded  of  azoospermism 
from  bilateral  sarcomatous  or  carcinomatous  degeneration 
of  the  epididymis.  I  have  myself  witnessed  the  same  result 
in  a  case  of  double  syphilitic  epididymitis,  the  indurations 
having  made  their  appearance  on  the  seventy-second  day 
after  the  first  observation  of  the  initial  lesion. 

1  Archives  Generales,  ser.  4,  t.  xiv.  p.  406,  and  t.  xv.  p.  40;  and  ser.  5,  t.  ii. 
p.  257. 


OBLITERATION    OF    THE    EXCRETORY    PASSAGES.  89 

A  most  important  inquiry  in  connection  with  obliteration 
of  the  excretory  apparatus  of  the  testes  is,  whetlier  the 
functional  activity  of  the  opposite  gland  is  abrogated  when 
the  lesion  is  confined  to  one  side.  Liegeois'  found  in  thir- 
teen examinations  of  the  discharge  of  persons  affected  with 
unilateral  epididymitis  that  the  number  of  spermatozoa  was 
greatly  diminished;  and  he  refers  to  three  cases  of  Hirtz, 
Duplay,  and  Gosselin,  in  which  the  spermatic  fluid  was 
entirely  devoid  of  those  bodies.  As  the  same  occurrence 
is  witnessed  in  tubercular  epididymitis  of  one  side,  Liogeois 
believes,  and  Ultzmann^  agrees  with  him,  that  the  testes  are 
so  closely  united  by  reflex  ties  that  unilateral  epididymitis 
may  abolish  the  functions  of  the  opposite  gland,  and  thereby 
produce  sterility.  This  conclusion  is  supported  by  five 
cases  of  unilateral  epididymitis  in  which  spermatozoa  were 
entirely  absent,  recorded  by  Kehrer  i^  but  it  is  utterly  at 
variance  with  observations  based  upon  analogous  conditions. 
Duplay,  for  example,  has  reported  six  instances  of  oblit- 
eration of  one  vas  deferens  with  spermatozoa  in  the  epi- 
didymis of  the  opposite  side ;  and  Godard  shows  that 
congenital  absence  of  one  excretory  duct,  or  even  of  one 
testis,  exerts  no  effect  upon  the  generative  functions. 

In  bilateral  gonorrhoeal  epididymitis  the  inflammatory 
new  material  may  be  seated  in  the  interior  of  the  canals,  in 
their  walls,  or  in  the  interstitial  connective  tissue,  and  the 
resulting  obstruction  or  induration  is  very  liable  to  be  per- 
manent and  incurable,  since,  of  eighty-three  cases  recorded 
by  Gosselin,  Godard,  and  Liegeois,"*  the  spermatozoa  re- 
turned in  only  eight.  The  testes  themselves  continue  to 
secrete  and  preserve  their  normal  volume  and  appearances, 

1  Loc.  cit.,  p.  541.  2  Wiener  Klinik,  1879,  p.  156. 

^  Op.  cit.,  pp.  79  and  82.  *  Loc.  cit.,  p.  380. 


90  AZOOSPERMISM. 

and  as  the  subjects  ejaculate  they  are  not  aware  that  they 
are  sterile.  Liegeois  found  in  twenty-one  instances  that 
impotence  was  present  in  eight ;  but  of  twenty  cases  ob- 
served by  Gosselin  all  were  thoroughly  potent.  The 
former'  states  that  the  ejaculated  fluid  is  rarely  milky-white, 
as  in  the  normal  condition,  and  that  it  possesses  a  yellowish 
tint  when  leucocytes  are  present  in  large  numbers  ;  while 
Gosselin^  could  not  trace  any  variations  from  the  natural 
color,  quantity,  odor,  and  consistence.  In  a  case  of  azoo- 
spermism  from  double  epididymitis,  Nepveu^  detected  in 
the  discharge  hyaline  cylinders  which  were  casts  of  the 
vasa  deferentia,  and  which  frequently  attained  a  length  of 
from  three  to  five  centimetres. 


F.— ABNORMAL  CONDITIONS  OF  THE  SEMEN. 

The  quality  and  composition  of  the  ejaculated  seminal 
fluid  are  liable  to  be  materially  altered  by  sexual  excesses, 
by  various  exhausting  diseases,  and  by  inflammatory  condi- 
tions of  the  epididymes,  vasa  deferentia,  seminal  vesicles, 
prostate,  and  urethra,  which  are  entitled  to  a  detailed  ex- 
amination. 

«•  Temporary,  or  physiological,  absence  of  the  sperma- 
tozoa may  be  induced,  in  perfectly  healthy  men,  by  sexual 
excesses,  and  the  frequent  repetition  of  the  act  of  coition 
renders  the  semen  more  and  more  watery  and  scanty,  so 
that  it  consists  merely  of  the  secretions  of  the  accessory 
glands.      In    the   case   of  a   medical   student,    recorded   by 

^  Loc.  cit.,  p.  511.  2  Archives  Generales,  ser.  5,  t.  ii.  p.  267. 

^  Gazette  Medicale  de  Paris,  1874,  p.  32. 


ABNORMAL    CONDITIONS    OF    THE    SEMEN.  91 

Liegeois/  who  indulged  in  three  or  four  connections  daily 
for  ten  successive  days,  repeated  examinations  of  the  emis- 
sions demonstrated  the  complete  absence  of  spermatozoa. 
Some  months  later,  after  an  abstinence  of  three  weeks, 
they  were  detected  in  large  numbers.  The  case  of  Casper^ 
is  so  interesting  in  this  respect  that  it  is  quoted  entire  :  "A 
vigorous  naturalist,  sixty  years  of  age,  a  married  man,  and 
father  of  a  large  family,  and  accustomed  to  the  use  of  the 
microscope,  whom  I  had  interested  in  this  question,  exam- 
ined with  me  for  some  time  continuously  his  own  semen 
after  coitus.  Here  we  found  the  greatest  variations,  which 
were  accurately  noted  by  both  of  us  together.  After  coitus 
on  the  third  day,  reckoning  from  the  last  performance  of 
the  act,  there  was  a  large  number  of  very  small  sperma- 
tozoa ;  after  renewed  coitus  on  the  fourth  day,  few  and 
small ;  after  a  pause  of  only  two  days,  none  ;  after  a  pause 
of  only  one  day  there  was  only  a  watery  sperma,  in  which 
no  zoosperms  were  found.  At  another  time,  on  the  fifth 
day  after  the  last  coitus,  the  zoosperms  were  very 
numerous  ;  another  time,  after  a  pause  of  six  days,  they 
were  few,  but  large  in  size ;  four  months  after  the  last  ex- 
amination, and  seventy-two  hours  after  the  last  act,  the 
zoosperms  were  comparatively  very  sm.all,  and  at  another 
time,  on  the  third  day  after  the  last  act,  they  were  innumer- 
able. Immediately  after  coitus,  and  before  emptying  the 
bladder,  the  urethra  was  twice  examined.  Twenty-four 
hours  after  the  last  act,  a  drop  passed  out  of  the  urethra 
exhibited  numerous  small  zoosperms  ;  at  another  time,  after 
a  three  days'  interval,  there  was  not  a  single  zoosperm." 
The  foregoing  observations  are  corroborated  by  experi- 

'  Loc.  cit.,  p.  247.  ^  Op.  cit.,  p.  292. 


92  AZOOSPERMISM. 

ments  on  animals.  Thus,  Plonnies,'  by  electrical  irritation 
of  the  spinal  cord  of  dogs,  has  proved  that  the  frequent 
repetition  of  seminal  evacuations  results  not  only  in  a  strik- 
ing diminution  in  the  quantity  of  semen  and  spermatozoa, 
but  frequently  in  the  entire  absence  of  the  latter.  Hence, 
erection  and  ejaculation  may  be  entirely  normal,  without 
the  semen  containing  fructifying  elements. 

Permanent  absence  of  the  spermatozoa  is  said  to  occur 
now  and  then  as  an  idiopathic  affection.  The  only  cases 
bearing  upon  this  point,  of  which  I  have  any  knowledge, 
are  those  narrated  by  Hirtz."*  Two  young,  robust,  married, 
but  childless  men,  performed  coition  with  unusual  vigor. 
The  ejaculations  were  never  followed  by  the  sense  of 
fatigue  so  generally  experienced  after  intercourse,  and  the 
fluid  was  void  of  spermatozoa.  While  it  is  impossible  to 
explain  these  cases  satisfactorily,  I  am  inclined  to  believe 
that  the  "unusual  vigor"  which  they  displayed  points  to 
their  having  indulged  too  often  in  proportion  to  their 
powers,  and  that  they  are  to  be  classed  among  the  cases  of 
azoospermism  from  sexual  excesses. 

^-  One  of  the  most  common  causes  of  infertile  semen  is 
nervous  exhaustion  or  neurasthenia,  attended  with  abnormal 
seminal  and  prostatic  discharges,  and  with  various  degrees 
of  impotence.  This  condition  is  usually  brought  about  by 
onanism,  venereal  excesses,  or  ungratified  desires,  and  may 
be  regarded  as  an  exaggerated  or  advanced  stage  of  the 
preceding  variety  of  azoospermism.  As  a  result  of  im- 
paired nutrition,  induced  by  perverted  innervation,  the 
secretory  activity  of  the  testes  is  interfered  with,  and  either 
the  evolution  of  the  spermatozoa  is  arrested,  or  their  num- 

1  Inaug.  Diss.     Rostock,  1876. 

*  Gazette  de  Strasbourg,  No.  5,  1861. 


ABNORMAL    CONDITIONS    OF    THE    SEMEN.  93 

ber  and  their  activity  are  diminished.  In  addition  to  this 
factor,  it  is  highly  probable  that  the  zoosperms  are  unable 
to  exist  in  the  altered  prostatic  fluid,  since  the  microscope 
shows  that  they  are  motionless,  and  thereby  confirms  the 
view  of  Kraus  and  Wilson,  to  which  allusion  has  already 
been  made  in  the  study  of  normal  semen,  that  the  vitality 
of  the  spermatozoa  is  dependent  upon  the  presence  of  the 
healthy  secretion  of  the  prostate. 

The  investigations  of  Rosenthal,^  Ultzmann,^  and  Cursch- 
mann^  demonstrate  that,  when  potence  is  as  yet  little 
affected,  and  pollutions  are  merely  beginning  to  overstep 
the  natural  limits,  the  ejaculated  fluid  is  unchanged.  When 
the  pollutions  are  more  frequent,  and  there  are  diurnal  dis- 
charges, the  spermatozoa  are  smaller  and  more  scanty ; 
their  movements  are  less  active  than  in  the  normal  condi- 
tion, are  liable  to  be  abolished  in  less  than  an  hour,  and  are 
incapable  of  being  reawakened  by  alkaline  solutions. 
Spermatic  crystals,  moreover,  form  more  rapidly,  and  in 
greater  abundance  than  in  health.  In  the  worst  cases,  or 
in  those  characterized  by  diurnal  and  nocturnal  pollutions, 
and  by  the  presence  of  semen  in  the  urine,  the  spermatozoa 
are  either  entirely  absent,  or,  if  they  are  present,  they  are 
motionless,  stunted,  or  variously  deformed.  In  these 
advanced  instances  the  semen  is  frequently  seen  to  have 
undergone  fatty  degeneration,  as  indicated  by  granular  epi- 
thelium, by  molecular  detritus,  and  even  by  oil  globules  in 
the  protoplasm  of  the  altered  spermatozoa.  Spermatic 
crystals  are  also  abundant,  and  appear  quickly. 

These  observations  are  in  accord  with  those  of  Lalle- 


'  Wiener  Klinik,  May,  iS8o,  p.  137. 
^  Wiener  med.  Presse,  1876,  p.  599. 
^  Ziemssen's  Cyclop£edia,  Amer.  ed.,  vol.  viii.  p.  852. 


94  AZOOSPERMISM. 

mand ;'  and  I  have  been  able  to  confirm  them  by  the  few- 
examinations  that  I  have  made,  to  which  I  allude  in  the 
succeeding-  chapter,  and  of  which  the  following  case  is  a 
good  illustration : 

Case  XXII.  A  commercial  traveller,  forty-five  years  of  age^_ 
who  had  masturbated  a  great  deal  in  his  youth,  and  who  had  con- 
tracted gonorrhoea  twenty  years  before  I  saw  him,  states  that 
he  has  been  constantly  annoyed  for  the  last  two  years  by  a  dis- 
charge which  is  increased  by  straining  at  stool,  and  by  toying  with 
women  without  gratifying  his  passions,  a  practice  in  which  he 
indulged,  as  he  feared  to  have  sexual  congress  on  account  of  feeble 
erections.  I  detected  a  stricture,  calibre  19,  at  five  inches  and  a 
half  from  the  meatus,  along  with  a  granular  patch  immediately 
behind  the  coarctation,  and  hyperaesthesia  of  the  prostatic  urethra. 
On  withdrawing  the  explorer,  the  bulb  brought,  away  a  consider- 
able discharge,  which,  under  the  microscope,  presented  a  few  pus 
corpuscles,  granular  epithelium,  and  detritus,  and  a  few  motionless 
and  deformed  spermatozoa,  several  of  which  were  occupied  by  fat 
globules.  On  examining  the  slide  a  few  hours  subsequently,  I 
also  discovered  numerous  spermatic  crystals. 

Fatty  degeneration  of  the  spermatozoa  has  also  been 
observed  by  Bianchi^  as  rod-like  bodies  made  up  of  shining^ 
points,  which  disappeared  on  the  addition  of  ether. 

In  a  case  of  impotence  from  masturbation,  complicated 
by  spermatorrhoea,  Heitzman^  found  that  the  heads  of  the 
zoosperms  were  not  much  wider  than  the  tails,  and  that 
their  movements  were  very  feeble. 

7.  TJie  relation  of  general  diseases  to  anomalies  of  the  semen 
is  a  subject  in  regard  to  which  widely  different  views  are 

1  Op.  cit.,  3d  Amer.  ed.,  Phila.,  1858,  p.  265. 
''■  Schmidt's  Jahrbiicher,  1879,  ^^-  clxxxi.  p.  38. 
^  New  York  Med.  Journal,  August,  1879,  P-  ^5^- 


ABNORMAL    CONDITIONS    OF    THE    SEMEN.  95 

entertained.  While  there  is  no  reason  for  beheving  that 
acute  maladies  impair  the  fertility  of  the  semen  of  adults, 
it  is  quite  certain  that  both  acute  and  chronic  affections  of 
old  age,  and  chronic  diseases  in  the  adult,  not  infrequently 
lead  to  a  suspension  of  the  evolution  of  spermatozoa. 

The  investio-ations  in  this  direction  have  been  confined 
almost  exclusively  to  consumptives,  in  whom,  as  is  well 
known,  the  parenchyma  of  the  testes  is  usually  very  moist, 
pale,  and  ansemic,  and  in  whom  the  epithelium  of  the  tubules 
has  not  uncommonly  undergone  fatty  degeneration.  The 
frequency  of  azoospermism  in  phthisis,  despite  the  changed 
condition  of  the  testes,  has,  however,  been  greatly  exag- 
gerated. Lewin,'  Davy,^  Duplay,^  and  Dieu'*  examined  the 
secretions  of  the  epididymes,  vasa  deferentia,  and  vesiculae 
seminales  of  thirty-five  persons  dead  of  pulmonary  tubercle, 
and  found  spermatozoa  in  twenty-three,  or  65.7  per  cent.; 
and  in  thirteen  inspections  of  the  fluid  at  the  orifice  of  the 
urethra,  or  pressed  out  of  that  passage,  Lewin  discovered 
zoosperms  in  eight.  Hence,  the  semen  contained  fertile 
elements,  and  usually  as  numerous  as  in  healthy  persons, 
in  thirty-one,  or  64.5  per  cent.,  of  forty-eight  subjects  dead 
of  phthisis  ;  and  what  is  remarkable  is  the  fact  that  they 
were  present  in  62.5  per  cent,  of  the  semen  of  old  persons, 
arid  in  65  per  cent,  of  that  of  adults  principally  between 
thirty  and  forty  years  of  age.  The  accuracy  of  these  in- 
vestigations has  recently  been  confirmed  by  Busch,^  who 
detected  spermatozoa  in  the  fluids  obtained  from  the  testes, 
epididymes,  and  vasa  deferentia  of  twenty-eight,  or  66.6 
per  cent.,  of  forty-two  phthisical  subjects  ;   but  it  is  to  be 

^  Deutsche  Klinik,  1861,  p.  319. 
^  Edinb.  Med,  and  Surg.  Journ.,  July,  1839,  p.  i. 
^  Ante.  *  Ante. 

^  Ztbchr.  f.  Biol.,  Bd.  xviii.  p.  496. 


96  AZOOSPERMISM. 

noted  that  they  were  abundant  in  only  eight.  From  these 
statements,  it  will  be  seen  that  the  semen  of  consumptives 
contains  zoosperms  far  more  frequently  than  certain  writers 
would  lead  us  to  believe.  Godard  was  of  the  opinion  that 
spermatozoa  were  absent  in  persons  who  had  become  con- 
sumptive at  the  age  corresponding  to  the  establishment 
of  the  spermatic  secretion  ;  but  that  they  persisted  when 
tuberculosis  began  after  that  period. 

That  acute  and  chronic  diseases  do  impair  the  fertility 
of  the  semen  of  persons  advanced  in  life  is  well  shown  by 
the  investigations  of  Duplay  and  Dieu,  since  of  156  in- 
stances in  which  the  fluid  contained  in  the  vasa  deferentia 
or  vesiculse  seminales  of  old  men  was  examined,  sperma- 
tozoa were  found  in  only  one-half.  Dividing  the  cases  in 
accordance  with  the  periods  of  life — 

Of  25  sexagenarians  spermatozoa  were  discovered  in  17,  or  68  per  cent. 
"    76  septenarians  "  "  "  40,  "   59.2     " 

"    51  octogenarians  "  "  "  19,   "   37.2     " 

"      4  nonagenarians  "  "  "  o. 

In  none  were  they  present  after  the  age  of  eighty-six,  and 
they  decreased  pari  passu  with  advancing  years. 

On  analyzing  the  causes  of  death,  I  find  that  spermatozoa 
were  entirely  absent  in  affections  of  the  urinary  organs  ; 
that  they  were  present  in  only  38  per  cent,  of  diseases  of 
the  nervous  system  ;  and  that  they  were  discovered,  re- 
spectively, in  68,  70,  and  81  per  cent,  of  disorders  of  the 
lunors,  the  digestive  organs,  and  the  heart.  Hence,  we 
may  assume  that  while  diseases  of  the  kidney  and  brain 
exert  a  most  prejudicial  influence  upon  the  formation  of 
zoosperms,  afl"ections  of  the  other  great  systems  interfere 
with  their  development  to  only  a  slight  extent. 

Of  the  76  cases  in  which  spermatozoa  were  found,  they 
were  abundant  in  50,  and  fewer  than  usual  in  26.     They 


ABNORMAL  CONDITIONS  OF  THE  SEMEN.         97 

were  perfectly  formed  in  54;  and  in  22  their  tails  were 
absent  or  shortened,  and  they  varied  in  size.  From  these 
facts  we  may  infer  that  the  inability  of  old  men  to  procreate 
arises  more  from  impotence  than  from  the  composition  of 
their  semen;  and  this  view  is  supported  by  the  fact,  based 
upon  51  examinations  made  by  Duplay'  of  the  testes  of  men 
from  sixty  to  eighty- six  years,  that  the  secreting-  organs 
are  perfectly  normal  in  structure,  and  only  slightly  dimin- 
ished in  size  and  weight. 

The  gross  appearances  of  the  seminal  fluid  of  old  men 
are  worthy  of  notice,  since,  in  the  absence  of  minute  ex- 
amination, they  afford  inferential  aid  in  deciding  the  ques- 
tion of  the  absence  or  presence  of  spermatozoa.  When 
the  secretion  is  of  a  more  or  less  transparent  grayish  tint, 
thick,  viscous,  and  abundant,  it  is  almost  always  fertile  ;  but 
when  it  is  scanty,  and  either  watery  or  gelatinous,  sperma- 
tozoa are  almost  always  absent  ;  and  a  deep  brown  color, 
which  is  due  to  broken-down  blood  and  pigment,  favors  the 
latter  view. 

Constitutional  syphilis  does  not  appear  to  exert  much 
influence  upon  the  secretion  of  the  testes,  since  Liegeois^ 
and  Bryson^  detected  spermatozoa  in  the  fluid  ejaculated 
by  syphilitic  subjects  in  sixteen  cases  out  of  twenty-one,  and 
Lewin"  found  them  in  three  out  of  six  examinations  of  the 
contents  of  the  excretory  seminal  apparatus  of  men  dead 
of  that  affection. 

Under  this  head  may  be  mentioned  the  altered  composi- 
tion of  the  semen  produced  by  the  excessive  use  of  moi^phia, 
to  which  attention  has  been  called   by  Rosenthal. ^     A  man 

^  Archives  Generales,  ser.  5,  t.  vi.  pp.  136  and  439. 
^  Loc.  cit.,  p.  380. 

^  New  York  Medical  Abstract,  July,  1882,  p.  274. 
*  Loc.  cit.,  p.  319. 

^  W^iener  Klinik,  May,  1880,  p.  149. 
7 


AZOOSPERMISM. 


had  injected  under  the  skin,  on  account  of  cephalalgia  and 
insomnia,  from  nine  to  twelve  grains  of  morphia  daily  for  three 
years.  Paralysis  of  the  bladder  finally  ensued  ;  and  exami- 
nation of  the  whitish  fluid,  which  was  occasionally  forcibly 
expelled  with  the  last  drops  of  urine,  demonstrated  sper- 
matic crystals,  but  no  spermatozoa.  Under  proper  treat- 
ment, at  the  expiration  of  a  month,  when  the  morphia  had 
disappeared  from  the  urine,  a  specimen  of  the  semen  ejacu- 
lated during  coition  was  found  to  contain  living  zoosperms, 
but  they  were  not  so  abundant  or  so  lively  in  their  move- 
ments as  under  normal  circumstances.  In  a  second  case, 
in  which  nearly  eight  grains  of  morphia  had  been  injected 
daily  for  one  year,  minute  examination  of  a  nocturnal  pollu- 
tion disclosed  a  few  deformed  and  motionless  spermatozoa, 
which  did  not  react  on  the  addition  of  a  weak  alkaline 
solution. 

^-  Abnormal  density  of  the  semen  may  render  it  unfit  for 
fecundation.  Beigeh  narrates  a  case  in'  which  the  genital 
organs  were  normal,  but  in  which  repeated  examinations  of 
the  ejaculated  fluid  showed  that  it  was  thicker  and  more 
viscous  than  is  usual,  and  that  the  spermatozoa  were  motion- 
less and  closely  grouped  side  by  side.  The  addition  of  a 
few  drops  of  tepid  water  put  them  in  lively  motion  ;  so  that 
the  injecdon  of  a  smah  amount  of  lukewarm  water  into  the 
vagina,  after  coition,  was  advised,  and  the  woman  subse- 
quently bore  several  children. 

^-  Parnlent  semen,  which  is  met  with  principally  in  in- 
flammation of  the  epididymes,  vasa  deferentia,  seminal 
vesicles,  and  prostate,  may  occasion  the  death  of  its  essential 

'  Krank.  des  Weibl.  Geschlechts,  Bd.  ii.  p.  791. 


ABNORMAL  CONDITIONS  OF  THE  SEMEN.        99 

anatomical  elements,  as  in  the  following  case,  which  was 
under  my  care  in  1883  : 

Case  XXIII.  A  gentleman,  thirty  years  of  age,  contracted 
.gonorrhoea  in  1870,  or  rather  more  than  ten  years  before  I  saw  him, 
and  at  the  end  of  six  weeks  was  attacked  by  bilateral  epididymitis, 
v/hich  confined  him  to  his  bed  for  a  fortnight.  Up  to  1873  he  had 
always  had  an  ejaculation  on  coition,  but  during  the  succeeding  two 
years  he  indulged  so  rarely  that  he  does  not  remember  whether  he 
had  a  discharge  or  not.  He  married  in  1875,  and  although  he  has 
always  had  good  erections,  intercourse  was  not  completed  with  an 
emission ;  but  by  pressing  along  the  course  of  the  urethra,  he 
could  force  a  drop  of  sticky  fluid  out  of  the  meatus.  Exploration 
discovered  a  stricture,  calibre  14,  at  five  inches  and  three-quarters, 
and  great  hyperaesthesia  of  the  prostatic  urethra.  The  seminal 
vesicles  and  prostate  were  tender  on  pressure  with  the  finger  in 
the  rectum.  Having  detected  these  morbid  conditions,  I  learned, 
on  further  questioning,  that  intercourse  was  painful,  and  that  there 
was  a  constant  feeling  of  dull,  heavy  pain  in  the  rectum  which  was 
increased  at  stool.  On  the  12th  of  January,  188 1,  he  brought  me 
the  entire  quantity  of  urine  passed  less  than  an  hour  after  inter- 
course. Examination  of  the  sediment,  as  well  as  of  the  discharge 
which  I  removed  from  the  urethra  with  the  bulbous  explorer,  dis- 
closed rather  abundant  pus  corpuscles  and  epithelial  cells,  with 
some  of  the  latter  undergoing  fatty  degeneration,  crystals  of  oxa- 
late of  lime,  spermatic  crystals,  and  a  few  stunted  or  tailless  and 
dead  spermatozoa.  The  case  was,  therefore,  one  of  sterility  from 
aspermatism  dependent  upon  stricture  of  the  urethra,  and  of  azoo- 
spermism  from  inflammation  of  the  seminal  vesicles. 

Examples  of  symmetrical  spermatocystitis,  with  complete 
absence  of  spermatozoa,  have  been  reported  by  Marce,' 
Laborde,^  and  Octave  Guelliot  ;3  and  Heitzman'^has  met  with 

1  Gazette  des  Hopitaux,  1854,  p.  597. 

^  Gazette  Medicale  de  Paris,  1859,  P-  468- 

^  Des  Vesicules  Seminales,  Paris,  1883,  pp.  124  and  131. 

*  New  York  Med.  Journ.,  August,  1879,  P-  ^5^- 


100  AZOOSPERMISM. 

an  instance   of  unilateral  spermatocystitis   In   which   those 

elements  were  also  destroyed. 

Terillon,'  in  1880,  pointed  out  that  the  ejaculated  fluid  in 

acute   bilateral   gonorrhoeal    epididymitis   is  of  a  yellowish 

tint  vero-inor  on  screen,  and  that,  while  it  contains  abundant' 
000'  ' 

pus  corpuscles  and  a  few  large  granular  corpuscles,  sper- 
matozoa are  nearly  always  absent.  Thus  of  twelve  cases 
in  which  the  semen  was  examined  at  from  ten  to  ninety 
days  after  the  implication  of  the  second  testis,  or  on  the 
thirty-ninth  day,  on  an  average,  there  were  no  spermatozoa 
in  eiorht,  a  few  livinof  ones  in  three,  and  an  abundance  in 
one.  Even  several  years  after  the  complete  subsidence  of 
the  acute  symptoms,  when  the  epididymes  and  vasa  defer- 
entia  are  normal  in  volume  and  consistence,  though  tender 
on  handling,  the  discharge  may  retain  the  same  characters, 
but  in  a  less  pronounced  degree  ;  and  Terillon  illustrates 
this  important  statement  by  a  case  in  which  yellowish  azoo- 
spermous  semen,  which  contained  relatively  few  pus  cor- 
puscles, continued  to  be  emitted  six  years  after  the  cessation 
of  the  inflammation.  The  man  had  been  married  four 
years,  but  had  not  procreated  children. 

In  the  preceding  examples  it  has  been  seen  that  the 
vitality  and  the  changes  in  the  form  and  dimensions  of  the 
essential  anatomical  elements  of  the  semen  were  associated 
with  purulent  inflammation  of  the  excretory  passages  of 
that  fluid,  so  that  the  inference  is  justifiable  that  pus  is  de- 
structive of  their  evolution  and  life.  This  view  is  supported 
by  the  researches  of  Levy'  on  the  influence  exerted  upon 
the  viability  of  the  spermatozoa  by  the  perverted  secretion 
of  the  glands  of  the  cervix  in  endometritis.      Of  fifty-seven 

^  Des  Alterations  du  Sperme  dans  I'Epididymite  Blennorrhagique.    Annales 
de  Dermatologie  et  de  Syphiligraphie,  ser.  2,  t.  i.  p.  439. 
■^  Aerztliches  Intelligenzblatt,  1879,  -^d.  xxvi.  pp.  3  and  12. 


ABNORMAL    CONDITIONS    OF    THE    SEMEN.  101 

cases  in  which  the  secretion  after  coition  contained  an 
abundance  of  pus  corpuscles  and  epithehal  cells,  in  not  a 
single  one  were  many  spermatozoa  detected,  and  in  none 
did  their  movements,  which  were  feeble  from  the  first,  con- 
tinue for  more  than  five  hours  ;  whereas  he  frequently  found 
that  they  were  vigorous  in  the  cervical  mucus  of  healthy 
women  for  twenty-six  hours  after  congress. 

In  none  of  these  cases  were  the  phenomena  to  be  ascribed 
to  the  reaction  of  the  discharge.  Sims'  states  that  when 
the  cervical  secretion  is  rich  in  epithelial  cells  it  proves  de- 
structive of  the  spermatozoa  ;  and  he  ascribes  this  action 
to  its  density  and  not  to  its  chemical  action.  He,^  moreover, 
thinks  that  catarrh  of  the  prostate  is  as  deleterious  as  is 
uterine  catarrh ;  and  there  is,  indeed,  no  reason  why  a 
mucopurulent  discharge  of  the  urethra  should  not  kill  the 
spermatozoa.  Noeggerath^  believes  that  it  acts  as  a  poison  ; 
and  in  a  letter  which  I  received  from  him  in  1S83,  he  says, 
"the  poison  in  the  secretion  is  certainly  not  the  pus  cor- 
puscle, but  the  micrococci  which  infest,  not  only  the  leuco- 
cyte, but  also  the  menstruum  in  which  it  is  found  ;."  and  he 
refers  me  to  a  paper  on  the  subject  by  Neisser,  which,  how- 
ever, is  not  available.  While  these  views  are  hypothetical, 
they  are  worthy  of  further  investigation,  as  they  would  seem 
to  be  substantiated  by  a  case  of  sterility  from  diabetes 
mellitus  recorded  by  Beigel,"*  in  which  examination  of  the 
semen  contained  in  the  urine  disclosed,  in  addition  to  frag- 
ments of  spermatozoa,  abundant  micrococci  and  a  few 
cryptococci. 

^  Uterine  Surgery,  p.  390. 

^  New  York  Med.  Journ.,  vol.  viii.  p.  407. 

^  Trans.  Amer.  Gynec.  Soc,  vol.  i.  p.  287. 

*  Krank,  des  Weibl.  Geschlechts,  Bd.  ii.  p.  791. 


102  AZOOSPERMISM. 

?•  Bloody  semen  is  an  occasional  cause  of  azoospermism, 
the  essential  elements  being,  as  a  rule,  diminished  in  num- 
ber and  frequently  motionless  or  dead,  and,  in  some  cases, 
entirely  absent.  When  furnished  by  an  inflamed  prostatic 
urethra,  as  in  one  of  my  patients  suffering  from  bloody 
ejaculations,  no  influence  appears  to  be  exerted  upon  the 
number  and  movements  of  the  spermatozoa,  and  Robin' 
states  that  they  live  in  blood  for  four  or  five  hours.  When, 
however,  the  seminal  vesicles  are  the  seat  of  the  hemor- 
rhao-e,  and  the  blood  has  been  retained  for  some  time  in 
those  reservoirs,  being  intimately  mixed  with  the  semen, 
the  secretion  is  rust-colored,  or  of  a  dark  brown  or  choco- 
late tint,  and  the  spermatozoa  are  either  greatly  reduced  in 
number  or  altogether  wanting,  as  pointed  out  by  Dieu. 
These  facts  are  illustrated  by  a  case  of  chronic  spermato- 
cystitls  recorded  by  Rapin,^  and  by  two  cases  of  a  similar 
nature  observed  by  Guelliot.^  When  the  bleeding  is  the 
result  of  gonorrhoeal  epididymitis,  the  effect  produced  upon 
the  fructifying  elements  is  less  marked  than  when  it  is  in- 
duced by  inflammation  of  the  seminal  vesicles.  Thus,  in 
three  examples  from  the  practice  of  Molliere,'^  the  sper- 
matozoa were  dead  in  notable  numbers,  while  in  one  instance 
recorded  by  Fiirbringer^  they  were  numerous  and  in  active 
motion  at  the  end  of  three  days.  From  these  considera- 
tions it  follows  that  azoospermism  from  sanguineous  semen 
is  usually  dependent  upon  hemorrhage  connected  with  sper- 
matocystitis. 

^  Diet.  Encyclop.  des  Sciences  Medicales,  3d  ser.,  t.  xi.  p.  160. 

2  These  de  Strasbourg,  1859,  No.  491,  Obs.  II. 

^  Op.  cit.,  pp.  208  and  221. 

*  Diet.  Encyclop.  des  Sciences  Medicales,  3d  ser.,  t.  xvi.  p.  599. 

^  Volkmann's  Vortrage,  No.  207,  p.  1847. 


DIAGNOSIS.  103 

Diagnosis. — The  discrimination  between  anorchids  and 
cryptorchids  with  the  testes  retained  in  the  abdomen  is 
readily  made,  when  it  is  remembered  that  the  former  are 
impotent,  while  the  latter  complete  the  sexual  act  in  the 
usual  manner.  If  spermatozoa  have  never  appeared  in  the 
discharge,  the  question  of  congenital  absence  of  the  epi- 
didymes,  or  of  want  of  union  of  the  vasa  deferentia  with 
the  seminal  vesicles  or  the  epididymes,  may  be  entertained. 

In  all  other  cases  the  diagnosis  is  to  be  established  by 
repeated  examinations  of  the  semen,  since,  as  we  have 
already  seen,  that  fluid  is  liable  to  undergo  various  changes 
in  sterility  from  sexual  excesses,  masturbation,  ungratified 
venereal  desire,  obstruction  of  the  epididymes,  prostatitis, 
spermatocystitis,  and  epididymitis.  Normal  semen  slowly 
throws  down  a  white  sediment,  which  constitutes  from  one- 
third  to  one-half  of  the  discharge,  while  azoospermous 
semen  rapidly  precipitates  a  slight  sediment.  Under  ordi- 
nary circumstances,  the  formation  of  spermatic  crystals  is 
delayed  until  the  second  or  third  day  after  ejaculation,  and 
their  number  is  small.  In  semen  deprived  of  spermatozoa, 
on  the  other  hand,  the  crystals  appear  in  half  an  hour  ;  or 
somewhat  later,  if  there  are  few  spermatozoa.  The  earlier, 
therefore,  a  sediment  is  deposited,  and  the  more  rapidly 
and  abundantly  spermatic  crystals  form,  the  less  fertile  is 
the  discharge. 

Ultzmann'  describes  the  following  varieties  of  semen  in 
which  spermatozoa  are  not  found,  and  his  observations  have 
been  confirmed  by  myself  and  other  observers  : 

First,  watery,  transparent  semen,  which  is  normal  in 
quantity,  and  becomes  gelatinous  immediately  after  emis- 

Wiener  med.  Presse,  1876,  p.  599,  and  1878,  p.  78;  and  Wiener  Klinik, 
1879,  P-  156. 


104 


A  Z  O  O  S  P  E  R  BI I  S  M  . 


sion,  as  does  the  normal  secretion.  It,  however,  resumes 
its  fluid  state  when  it  is  thoroughly  cooled,  and  presents  a 
whey-like  appearance.     Its  relatively  slight  sediment  shows, 


Fig.  14. 


Watery  semen. 

under  the  microscope,  as  in  Fig.  14,  perfect  spermatic  crys- 
tals, a  few  'lymph  corpuscles,  cylinder  epithelium,  and  an 
abundance  of  fatty  detritus. 

Secondly,  colloid  sperm,  Fig.  15,  which  differs  from  the 
normal  discharge  only  in  the  absence  of  spermatic  crystals 
and  spermatozoa,  and  in  the  presence  of  abundant  epithe- 
lium which  has  undergone  colloid  degeneration,  and  of 
laminated  spherical  masses  of  various  dimensions. 

Thirdly,  catarrhal  and  purulent  semen,  which  deposits  a 
tolerably  abundant  whitish  or  yellowish  sediment,  is  of 
normal  consistence  and  quantity,  and  contains  an  abundance 
of  epithelium,  leucocytes,  and  a  few  blood  corpuscles,  and 
occasionally  a  few  deformed  and  motionless  spermatozoa. 


PROGNOSIS, 


105 


To  these  varieties  I  may  add,  fourthly,  bloody  semen, 
which  has  a  dark  brown  or  chocolate  tint,  from  the  intimate 
admixture   of  the   two   fluids  in   the   seminal  vesicles,  and 


Fig.  15. 


iOO 

Colloid  semen. 


which  contains  small  clots,  numerous  normal  and  altered 
red  corpuscles,  pigmented  granules,  and  minute  sympexions. 
When  the  semen  is  discharged  with  the  urine,  it  is  to 
be  remembered  that  the  movements  of  the  spermatozoa 
are  arrested  if  the  latter  fluid  is  acid  or  ammoniacal  ; 
whereas  they  are  not  materially  interfered  with  if  the  urine 
is  neutral  or  slightly  alkaline. 

Prognosis. — Azoospermism  offers,  in  the  large  majority 
of  cases,  little  encouragement  as  regards  the  prospect  of 
permanent  relief;  and  the  prognosis  depends  upon  its  ex- 
citing cause  and  the  amenability  of  the  cause  to  treatment. 

In  congenital  absence  of  the  testes  or  deficiency  of  their 


106  AZOOSPERMISM. 

excretory  passages,  cryptorchidism,  progressive  atrophy, 
parenchymatous  inflammation,  and  total  disorganization 
from  tubercle  and  morbid  growths,  as  well  as  in  tubercle, 
sarcoma,  and  carcinoma  of  the  epididymes,  the  absence  of 
spermatozoa  is,  with  few  exceptions,  permanent  and  abso- 
lute. In  cases  of  arrest  of  development,  the  prognosis 
should  be  guarded,  since  the  testes  may  resume  their  pro- 
per functions  under  amorous  influences.  Thus,  in  the 
remarkable  example  recorded  by  Wilson,'  the  penis  and 
testicles  of  a  man,  twenty-six  years  of  age,  were  not 
larger  than  those  of  a  boy  of  eight  years  of  age.  He 
had  never  had  sexual  desires  until  he  met  his  intended 
wife  ;  and  in  two  years  after  marriage  he  had  become  a 
father,  and  the  organs  had  increased  nearly  to  the  usual 
size.  The  chances  in  favor  of  a  return  of  the  fecundating 
elements  are  good  when  the  affection  arises  from  sexual 
excesses,  masturbation,  or  ungratified  passion,  overindul- 
gence in  morphia,  and  epididymitis  from  ordinary  causes; 
while  they  are  not  promising  in  cases  of  syphihtic  epi- 
didymitis and  orchitis,  and  in  gonorrhoea!  epididymitis. 
Liegeois^  examined  the  semen  of  twenty-eight  persons 
affected  with  bilateral  epididymitis,  and  there  were  no 
spermatozoa  in  twenty-one.  Of  the  seven  in  which  sper- 
matozoa had  returned,  only  two  were  of  gonorrhoeal  origin  ; 
so  that  the  prognosis  is  far  more  favorable  when  the  indur- 
ation depends  upon  common  causes  than  when  it  follows 
blennorrhaeia.  In  the  eonorrhceal  cases  with  a  return  of 
zoosperms,  the  induration  lasted  only  ten  days  in  one,  and 
in  the  other  only  one  side  was  seriously  affected ;  while  in 
those    in    which    the    azoospermism    was    permanent,    the 

^   Lect.  on  the  Urin.  and  Gen.  Organs,  p.  424. 
^  Loc.  cit.,  p.  380, 


TREATMENT.  107 

inflammation  had  lasted  from  fifteen  to  sixty  days.  Hence, 
the  light  cases  are  of  far  more  favorable  prognostic  import 
than  the  intense  ones.  Liegeois,  moreover,  found  that  the 
induration  persisted  partially  or  completely  in  fifteen  of  the 
twenty-one  cases  of  absolute  azoospermism  ;  but  that  the 
epididymes  seemed  normal  to  the  touch  in  six.  Of  the 
seven  in  which  the  functions  of  the  testes  were  reestab- 
lished, five  were  free  from  induration  ;  and  in  two,  which 
were  not  of  gonorrhoeal  origin,  the  induration  persisted  ; 
so  that  absence  of  swelling  and  hardness  is  not  positively 
indicative  of  a  return  of  fertility.  In  such  cases  the  canal 
of  the  epididymis  is  strictured  or  obliterated. 

As  a  prognostic  aid,  the  ejaculated  fluid  should  be 
examined  in  all  cases  of  bilateral  epididymitis.  If  it  pre- 
sents the  characters  of  watery  or  colloid  sperm,  the  absence 
of  spermatozoa  will,  in  all  probability,  be  permanent. 

Treatment. — The  management  of  azoospermism  is,  as  a 
rule,  most  unsatisfactory.  When  it  depends  upon  chronic 
debilitating  diseases  and  the  excessive  use  of  morphia,  the 
remedies  are  to  be  addressed  to  the  primary  affection  and 
to  the  breaking  up  of  the  habit.  Abstinence  is  enjoined 
when  it  is  due  to  sexual  excesses  or  masturbation  ;  and 
moderation  should  be  observed  when  the  functions  of  the 
testes  are  restored. 

In  advancing  atrophy  of  the  testes,  provided  it  is  not  a 
symptom  of  lesions  of  the  cerebro-spinal  system,  galvanism 
holds  forth  some  prospect  of  success.  The  positive  pole 
should  be  applied  over  the  lumbar  portion  of  the  spinal 
column,  and  the  negative  pole  should  be  passed  over  the 
affected  organs,  the  precautions  being  taken  to  employ 
weak  currents  and  to  limit  the  daily  sittings  to  two  or 
three  minutes. 


108  AZOOSPERMISM. 

Azoospermism  in  cryptorchids  may  be  prevented  if  the 
subjects  are  seen  sufficiently  early  in  life,  and  if  the  testes 
are  retained'  in  the  groins,  by  carrying  out  the  suggestion 
of  Curling'  to  promote  their  descent  into  the  scrotum  by 
gentle  and  repeated  traction.  In  children  the  retained 
organs  enjoy  great  mobility ;  and  the  manoeuvres  might 
succeed  in  adolescents  and  young  adults,  in  whom  the 
testes  are,  however,  usually  fixed.  Sir  Astley  Cooper 
witnessed  in  "  many  cases  "  their  descent  from  the  thir- 
teenth to  the  seventeenth  year,  and  even  as  late  as  the 
twenty-first  year;  and  I  myself  have  known  it  to  occur  still 
later,  as  in  the  following  example : 

Case  XXIV.  In  a  widower,  forty-six  years  of  age,  under  my 
care  for  impotence  in  1883,  the  right  testis  remained  in  the  inguinal 
canal  until  six  months  after  his  marriage,  at  the  age  of  twenty-four, 
when  it  passed  into  the  scrotum,  and  is  now  soft,  tender,  and  of 
about  one-third  the  volume  of  its  fellow.  In  its  descent  it  was 
accompanied  by  a  portion  of  the  intestine. 

The  arrest  of  the  evolution  of  spermatozoa  in  syphilitic 
orchitis  may  be  anticipated,  if  the  disease  be  recognized 
within  a  few  weeks,  by  the  internal  administration  of  iodide 
of  potassium  and  bichloride  of  mercury  ;  or  the  latter  agent 
may  be  replaced  by  mercurial  inunctions,  the  testes  in  the 
meanwhile  being  properly  supported.  Syphilitic  epididy- 
mitis, which  I  have  occasionally  met  with  as  a  secondary 
symptom,  readily  yields  to  a  mercurial  course. 

In  bilateral  epididymitis  early  and  vigorous  antiphlogistic 
treatment  will  usually  preserve  the  functions  of  the  testes. 
The  means  upon  which  I  place  the  most  reliance  are  strict 
recumbency,  light  diet,  a  brisk  purgative,   the  saline  and 

^  Op.  cit.,  p.  38. 


ASPERMATISM.  109 

antimoriial  mixture  with  a  few  drops  of  tincture  of  aconite 
pushed  to  the  extent  of  provoking-  sHght  nausea,  and  keep- 
ing the  parts  well  elevated  and  surrounded  with  absorbent 
cotton,  wet  with  a  strong  solution  of  acetate  of  lead  and 
laudanum.  If,  despite  these  measures,  indurations  remain 
after  the  active  symptoms  have  subsided,  they  may  fre- 
quently be  made  to  disappear  under  the  exhibition  of 
iodide  of  potassium  and  bichloride  of  mercury,  along  with 
the  local  use  of  mercurial  ointment,  or  oleate  of  mercury, 
or  an  ointment  composed  of  one  drachm  of  iodoform,  two 
drachms  of  balsam  of  Peru,  two  drops  of  oil  of  gaultheria, 
and  five  drachms  of  cosmoline.  This  treatment  should  be 
steadily  maintained,  as  the  most  chronic  cases  may  ter- 
minate favorably.  Thus,  Gosselin,  Godard,  and  Curling 
record  a  return  of  spermatozoa  after  eight,  eighteen,  and 
twenty-four  months ;  and  Godard  even  narrates  an  in- 
stance of  cure  in  which  the  indurations  had  lasted  for  ten 
years.  In  all  cases  particular  care  should  be  observed  to 
guard  against  recurrence  of  the  inflammation. 

Finally,  when  the  semen  is  too  thick,  as  in  the  case  of 
Biegel,  narrated  on  page  98,  although  nothing  can  be 
done  in  the  way  of  medication,  so  far  as  the  man  is  con- 
cerned, impregnation  may  be  insured  by  the  injection  of  a 
small  quantity  of  saccharine  or  alkaline  tepid  water  into 
the  vagina  after  sexual  congress. 


Sect.  III.    Aspermatism. 

Aspermatism  is  the  variety  of  sterility  in  which  sexual 
intercourse  is  not  finished  with  the  ejaculation  of  semen, 
either  because   that  fluid   does  not  enter  the  urethra,  or 


110  ASPERMATISM. 

because  its  forcible  expulsion  is  prevented  by  some  ob- 
stacle in  the  urethra  anterior  to  the  prostate  gland.  The 
term  is,  therefore,  restricted  to  those  cases  in  which  the 
lesions  are  seated  between  the  seminal  vesicles  and  the 
urinary  meatus. 

Nonemission  may  be  congenital  or  acquired,  and  per- 
manent or  temporary ;  and  it  may  depend,  first,  upon 
seminal  fistulae;  secondly,  upon  obstruction  of  the  ejacu- 
latory  ducts  or  the  urethra ;  thirdly,  upon  deficient  excita- 
bility of  the  spinal  ejaculatory  centre ;  fourthly,  upon 
abolished  sensibility  of  the  nerves  of  the  penis;  and,  fifthly, 
upon  the  inhibitory  action  of  the  brain  over  the  centre  for 
ejaculation.  Hence,  in  accordance  with  its  etiology,  it  may 
be  Organic,  Atonic,  Ansesthetic,  and  Psychical. 


A.— ORGANIC  ASPERMATISM. 

The  discharge  of  seminal  fluid  into  the  urethra  may  be 
prevented,  a,  by  seminal  fistulae  ;  /?,  by  congenital  vices  ; 
7,  by  inflammatory  lesions  of  the  ejaculatory  ducts  and  the 
prostate  ;  and,  f>,  by  sympexions  ;  and  the  escape  of  semen 
from  the  urethra  may  be  due,  e.  to  stricture  of  that  pas- 
sage, to  a  tight  phimosis,  or  to  induration  of  the  corpora 
cavernosa. 

a.  Seminal fistidcB,  the  result  of  wounds  or  pathological 
lesions  of  the  seminal  vesicles  and  their  excretory  ducts^ 
may  constitute  a  cause  of  nonemission.  Thus,  Sabatier' 
refers  to  a  case  of  rectovesical  lithotomy,  followed  by  the 
establishment  of  a  flstulous  tract  between  the  two  cavities,, 
through  which  the  semen  was  ejaculated  into  the  rectum ; 

1  Med.  Oper.,  1832,  t.  iv.  p.  342. 


LESIONS    OF    THE    EJACULATORY     DUCTS.  Ill 

and  in  a  case  of  a  similar  nature,  from  the  practice  of 
Simonin/  there  was  no  external  escape  of  the  semen  in 
masturbation,  and  it  was  mixed  with  the  feces  after  coition. 
Covillard^  has  recorded  a  curious  instance  of  the  passage 
of  urinary  calculi  through  fistulous  openings  in  the  peri- 
neum and  inner  side  of  the  thigh,  in  which  the  semen  fol- 
lowed the  same  routes. 

(3.  Congenital  occbision^  absence,  and  deviation  of  the  ejacu- 
latory  ducts  have  been  rarely  met  with.  Schmitt^  examined 
a  man,  thirty-five  years  of  age,  who  had  never  had  an 
emission  either  when  awake  or  asleep,  although  his  power 
to  cohabit  was  unimpaired.  He  had  not  suffered  from 
gonorrhoea,  and  his  external  organs  were  perfect ;  but  the 
prostate  could  be  felt  through  the  rectum  merely  as  a 
small,  flat  body,  and  the  seminal  vesicles  appeared  to  be 
atrophied.  Ultzmann^  records  two  cases  of  vigorous  men, 
in  whom,  as  in  the  preceding  instance,  there  was  no  history 
of  gonorrhoea,  and  who  had  never  been  able  to  ejaculate 
during  coition  or  under  the  influence  of  a  dream,  although 
nothing  abnormal  could  be  discovered  in  regard  to  their 
reproductive  organs.  Munroe'  describes  a  similar  condi- 
tion of  aflairs  in  a  robust  man,  twenty-eight  years  of  age. 
Under  no  circumstances  had  there  ever  been  an  emission  ; 
but  a  drop  or  two  of  clear  mucus  could  be  pressed  out  of 
the  urethra  after  intercourse,  and  examination  of  the  urine 
passed  soon  afterwards  disclosed  abundant  spermatozoa. 

While  in  the  case  of  Schmitt  it  is  highly  probable   that 

^  Bull,  et  Mem.  de  la  Soc.  de  Chir.,  1880,  t.  vi.  p.  166. 
"^  Observations  latrochirurgiques,  1839,  Obs.  9. 

*  Wiirzburg  med.  Zeitschrift,  1862,  Hd.  iii.  p.  361. 

*  Wiener  Klinik,  January,  1885,  p.  5. 

^  Boston  Med.  and  Surg.  Journ.,  Feb.  21,  1867,  p.  62. 


112  ASPERMATISM. 

the  atrophied  prostate  occluded  the  ejaculatory  ducts,  the 
cause  of  the  trouble  in  those  of  Ultzmann  must  remain  a 
matter  of  conjecture,  although  he  ascribes  it  to  congenital 
absence  of  excitability  of  the  reflex  centre  for  ejaculation. 
As  the  men,  however,  never  emitted  seminal  fluid,  we  may 
assume  that  the  ducts  were  obliterated,  or  absent.  That 
the  latter  inference  is  not  unfair  is  attested  by  a  prepara- 
tion' in  the  Hunterian  Museum,  in  which  the  ducts  are 
wanting,  and  in  which  the  remainder  of  the  sexual  organs 
are  completely  developed,  as  well  as  by  a  case  of  a  newly 
born  child,  described  by  Rindfleisch,^  in  which  the  ducts 
were  impermeable.  In  the  case  of  Munroe  there  was 
doubtless  a  congenital  deviation  of  the  orifices  of  the  ducts, 
so  that  the  semen  regurgitated  into  the  bladder  during 
intercourse. 

7.  Acquired  strichtre  or  obliteration  of  the  ejaculatory 
ducts  and  deviation  of  their  orifices,  the  results  of  inflamma- 
tion or  injury,  are  among  the  most  common  causes  of 
organic  aspermatism,  although  the  evidence  of  their  exist- 
ence is  based,  for  the  most  part,  on  the  symptoms  presented 
during  life.  In  his  researches  on  the  condition  of  the  genital 
oro-ans  of  old  men  dead  of  acute  and  chronic  diseases, 
Duplay^  made  some  interesting  observations,  which  afford 
post-mortem  proof  that  the  ejaculatory  ducts  undergo  cer- 
tain alterations  which  are  capable  of  preventing  ejaculation. 
In  one  both  ducts  were  entirely  destroyed,  and  were  sur- 
rounded by  tubercular  matter  from  the  neck  of  the  seminal 
vesicles  to  their  entrance  into  the  thickness  of  the  pros- 


*  Klebs,  Path.  Anat.,  p.  781. 

^  Virchow's  Archiv,  Bd.  81,  p.  521. 

•''  Archives  Generales,  ser.  5,  t.  vi.  pp.  437  and  438. 


CICATRICIAL    OCCLUSION    OF    THE    DUCTS.  113 

tate ;'  in  one  they  were  converted  into  small,  impermeable 
fibrous  cords,  and  the  man  had  had  a  catheter  retained  in 
his  bladder  for  a  long  time  for  retention  of  urine ;  in  one 
the  prostate  was  hypertrophied,  and  the  ducts  were  nar- 
rowed, but  pervious  to  semen  on  pressing-  the  seminal 
vesicles ;  in  one  both  ducts  were  strictured,  and  the  orifice 
of  the  right  was  completely  obliterated,  the  prostate  was 
enlarged  and  indurated,  and  the  verumontanum  was  hard 
and  of  the  size  of  a  big  pea  ;  and,  in  a  fifth  case,  the  orifices 
of  the  canals  were  strictured,  but  pressure  on  the  seminal 
vesicles  showed  that  they  were  open.  Ample  observation 
has,  moreover,  demonstrated  not  only  that  the  extension 
of  gonorrhoeal  inflammation  to  the  prostate  obstructs  its 
ducts  through  inspissation  of  the  catarrhal  secretion  of  its 
glands,  and  frequently  brings  about  adhesion  of  the  orifices 
of  the  ejaculatory  ducts,^  but  that  the  latter  may  be  occluded 
by  the  secondary  contraction  or  by  the  cicatrices  which 
result  from  abscess. 

Cicatricial  occlusion  of  the  ducts  from  deeply  seated 
abscess  has  been  observed  by  Kocher^  and  Ultzmann  ;'^ 
and  the  following  case  from  my  own  practice  demonstrates 
that  the  inability  to  ejaculate  was  due  to  suppuration  of  the 
prostate  and  obliteration  of  the  ejaculatory  ducts  : 

Case  XXV.  A  single  gentleman,  fifty  years  of  age,  contracted 
gonorrhoea  thirty  years  before  he  consulted  me,  and  two  years  ago 
suffered  with  symptoms  of  prostatic  obstruction,  which  were  fol- 
lowed by  suppuration  of  the  gland,  and  spontaneous  evacuation  of 
the  abscess.  Since  that  time  sexual  congress  has  been  followed 
by  a  somewhat  painful  sense  of  fulness  in  the  region  of  the  prostate 

1  Ultzmann  describes  a  similar  case  in  a  living  subject.     Loc.  cit.,  p.  7. 
^  Compare  with  Kraus,  Med.  Times  and  Gaz.,  1871,  vol.  i.  p.  272. 
^  Pitha  und  BiUrotli's  Hdbch.,  Bd.  iii.  Abth.  2,  Lief.  7,  p.  433. 
*  Loc.  cit.,  p.  6. 


114  ASPERMATISM. 

and   the   anus,  and  the  act  is  not  finished  with  an  ejaculation  of 
semen. 

On  exploration  of  the  urethra  I  detected  a  stricture,  calibre  21, 
at  the  bulbomembranous  junction,  a-long  with  marked  tenderness 
of  its  prostatic  portion  and  the  neck  of  the  bladder.  The  finger 
inserted  into  the  rectum  revealed  decided  diminution  in  the 
volume  of  the  prostate. 

♦ 
Injur)^  of  the  canals  in  bilateral  lithotomy,  or  even  in  the 
lateral  operation  during  the  extraction  of  the  calculus,  is 
liable  to  terminate  in  aspermatism.  I  have  myself  wit- 
nessed sterility  from  this  cause  in  tw^o  examples,  and  Tee- 
van  has  recorded  four  cases.' 

La  Peyronie''  describes  the  case  of  a  man,  the  father  of 
three  children,  who,  in  consequence  of  a  neglected  gonor- 
rhoea, lost  the  power  to  ejaculate,  although  semen  oozed 
away  shortly  after  coition.  On  post-mortem  examination 
a  cicatrix  was  discovered  on  the  summit  of  the  verumon- 
tanum,  which  had  so  changed  the  direction  of  the  orifices 
of  the  ejaculatory  ducts  that  they  looked  backwards  toward 
the  bladder.  Demeaux^  found  in  a  man,  twenty-three  years 
of  age,  after  an  abscess  of  the  perineum  from  a  fall,  that 
the  urine  passed  after  an  aspermous  coition  contained  nor- 
mal spermatozoa  ;  and,  as  the  urethra  was  not  strictured, 
but  the  perineum  was  diminished  in  size,  and  the  prostate 
was  drawn  down  lower  than  usual,  he  properly  inferred 
that  the  ejaculatory  ducts  had  been  displaced. 

^-  Aspermatism  may  arise,  as  Reliquef^  first  pointed  out, 
from  obsti^udion  of  the  ejaculatoi^y  canals  by  sympexions,  or 

^  Trans.  Clin.  Soc.  London,  vol.  vii.  p.  179. 

''■  Mem.  de  I'Acad.  Roy.  de  Chir.,  1819,  t.  i.  p.  316. 

^  Gaz.  des  Hopitaux,  No.  21,  i860. 

*  Ibid.,  1879,  PP-  S91  ^^d  915. 


SYMPEXIONS.  115 

concretions  composed  of  spermatozoa,  concrete  mucus,  epi- 
thelial cells,  and  refracting  granules,  and  formed  in  the 
seminal  vesicles.  In  the  three  cases  narrated  by  Reliquet, 
only  one  duct  was  involved,  and  he  ascribes  the  loss,  of 
power  to  ejaculate  to  the  compression  exerted  upon  the 
pervious  duct  by  the  distended  one,  and  to  the  arrest  of  the 
contraction  of  the  former  through  the  pain  experienced  at 
the  commencement  of  the  expulsive  act.  In  one  example 
the  finger  in  the  rectum  detected  a  bosselation  of  the  right 
lobe  of  the  prostate,  near  its  middle,  and  showed  the  boss 
to  be  continuous  with  the  corresponding  seminal  vesicles  ; 
and  in  a  second  case,  a  small  tumor,  due  to  retention  of  the 
semen,  was  discovered  at  the  site  of  the  ducts.  Bergh,'  of 
Copenhagen,  met  with  a  similar  condition  in  a  man  twenty- 
nine  years  of  age  ;  but  the  case  differed  from  the  cases  of 
Reliquet  in  that  the  nonejaculation  was  of  an  intermittent 
character.  The  patient  finished  his  first  connection  in  the 
usual  manner,  but  afterwards  there  was  merely  a  sensation 
of  distention  ;  although,  on  two  occasions  during  sleep, 
after  dinner,  there  was  an  abundant  discharge  of  semen. 
Bergh  advised  coition  with  a  condom,  with  a  view  to  ex- 
amine the  fluid,  if  any  should  be  evacuated.  During  the 
act,  the  man  felt  as  if  something  had  torn,  and  there  was  a 
seminal  discharge,  which  was  rich  in  spermatozoa  and  sym- 
pexions.  Subsequently  there  was  sometimes  an  emission, 
and  at  other  times  none.  In  an  instance  recorded  by 
De  Blegny,^  the  ducts  were  occluded  with  hard,  spherical 
concretions  as  large  as  peas  ;  and  the  verumontanum  was 
indurated,  and  of  the  volume  of  a  small  nut.  The  patient, 
a  widower,    sixty  years  of  age,   and  the  father  of  several 

1  Schmidt's  Jahrbiicher,  1879,  ^d.  clxxxi.  p.  36. 

^  Civiale,  Traite  Prat,  sur  les   Maladies  des  Organes  Genito-Urinaires,  t.  ii. 
P-  234- 


116  ASPERMATISM. 

children,  contracted  a  second  marriage,  but  was  unable  to 
ejaculate.  In  this  connection,  it  may  be  stated  that  Beck- 
mann'  discovered  a  concretion  as  large  as  a  cherry  in  the 
ejaculatory  duct  of  an  old  man,  the  organic  portion  of 
which  was  composed  of  spermatozoa,  and  the  inorganic 
portion  principally  of  phosphate  and  carbonate  of  lime. 
The  possibilit}'  of  the  formation  of  so  large  a  concretion, 
and  of  its  effecting  closure  of  the  opposite  duct,  should  be 
remembered  in  framing  a  diagnosis. 

«•  The  fourth  division  of  organic  aspermatism  includes 
those  cases  in  which  the  semen  is  discharged  into  the  ure- 
thra, but  its  escape  is  prevented  by  some  obstacle  anterior 
to  the  prostate  gland.  If  the  impediment  to  its  evacuation 
is  seated  in  the  posterior  portion  of  the  urethra,  the  greater 
part  will  usually  how  back  into  the  bladder,  and  minute 
examination  of  the  urine  passed  after  coition  will  disclose 
spermatozoa.  When  the  obstacle,  on  the  other  hand,  is 
situated  at  the  external  orifice,  the  semen  will  dribble  away 
with  the  subsidence  of  the  erection. 

The  most  common  cause  of  retention  of  the  seminal 
fluid  is  stricture  of  the  ^tretJira,  to  which  attention  was  first 
called  bv  Petit  ;^  and  it  is  not  difficult  to  conceive  how  an 
opening,  which,  in  the  flaccid  condition  of  the  penis,  admits 
of  the  passage  of  urine,  may,  during  erection,  when  the 
normal  calibre  of  the  urethra  is  naturally  diminished, 
become  so  narrowed  through  spasm  that  the  semen  is  con- 
fined in  the  canal  between  the  coarctation  in  front  and  the 
turoid  caput  gallinaginis  behind,  so  that  its  escape,  either 
forwards  or  backwards,  is  prevented  until  the  penis  becomes 

'  A'irchow's  Archiv,  Bd.  xv.  p.  540. 

-  Mem.  de  I'Acad.  Roy.  de  Chir.,  1819,  t.  i.  p.  323. 


STRICTURE    OF    THE    URETHRA.  117 

flaccid.  At  page  99,  I  have  narrated  the  case  of  a  man  in 
whom  the  stricture  admitted  a  No.  14  bulbous  explorer, 
and  in  whom  the  parts  behind  the  coarctation  were  very 
sensitive  ;  and  I  have  also  met  with  four  additional  exam- 
ples in  which  the  contractions  were  not  so  small,  and  of 
which  the  followino-  are  orood  illustrations  : 

Case  XXVI.  A  gentleman,  twenty-eight  years  of  age,  had 
masturbated  excessively  from  his  fourteenth  to  his  twenty-second 
year,  and  a  few  months  subsequently,  on  his  first  sexual  intercourse, 
discovered  that,  although  the  act  was  completed  with  the  usual 
sensation  and  painful  spasmodic  ejaculatory  movements,  there  was 
no  escape  of  semen  until  the  erection  subsided,  when  a  few  drops 
could  be  pressed  out  of  the  urethra.  Examination  of  the  urine 
passed  after  copulation  disclosed  abundant  spermatozoa;  and  a 
stricture,  calibre  22,  was  discovered  at  one-third  of  an  inch  behind 
the  meatus;  and  a  second,  calibre  18,  was  found  at  five  inches  and 
three-quarters  from  the  external  orifice.  The  prostatic  urethra  was 
extremely  sensitive,  and  he  suffered  from  prostatic  discharges  at 
stool. 

Case  XXVII.  A  merchant,  thirty-eight  years  of  age,  who  had 
masturbated  to  some  extent  when  a  youth,  and  who  had  always  in- 
dulged excessively  in  venery,  contracted  gonorrhoea  fifteen  years 
before  I  saw  him,  in  1885.  During  the  past  eight  years,  coition 
was  not  terminated  with  an  ejaculation,  but  the  semen  dribbled 
away  with  the  subsidence  of  the  erection.  There  were  marked 
signs  of  myelasthenia,  and  strictures,  calbre  27,  were  detected  just 
behind  the  meatus,  and  at  two  inches  and  a  half  and  five  inches 
from  the  orifice. 

In  these  cases,  the  fault  is,  in  my  opinion,  to  bejascribed 
less  to  the  organic  contraction  than  to  the  spasm  of  the 
muscular  walls  of  the  urethra  beneath  the  sensitive  mucous 
membrane,    through    which    the     opening    is    temporarily 


118  ASPERMATISM. 

occluded.  Hence,  such  cases  are  analogfous  to  those  of 
stricture  in  which  exposure  to  cold  and  wet,  or  acrid  condi- 
tions of  the  urine  react  on  the  inflamed  mucous  membrane, 
and  produce  retention  of  urine  from  spasmodic  contraction 
of  the  muscular  fibres  of  the  urethra  ;  and  it  would  prob- 
ably be  more  correct  to  describe  them  as  instances  of  re- 
tention of  semen  from  spasm.  Since  the  stricture  maintains 
the  inflammation  upon  which  the  spasm  depends,  it  is,  how- 
ever, needless  to  remove  the  cases  from  this  category. 

Other  examples  of  aspermatism  from  stricture  are  re- 
corded by  Curschmann,'  Acton, ^  and  Blackwood. ^  The 
case  of  Hirtz"*  terminated  by  a  spontaneous  cure  during 
coition,  which  was  attended  by  violent  pain,  and  followed 
by  severe  hemorrhage.  The  man  had  had  repeated  attacks 
of  gonorrhoea,  but  never  ejaculated,  and  spermatozoa  were 
detected  in  the  urine.  After  the  removal  of  the  obstacle, 
the  nature  of  which  is  not  clear,  his  wife  gave  birth  to  a 
child. 

The  second  impediment  to  the  spasmodic,  forcible  dis- 
charge of  the  semen  is  a  tight  phimosis,  of  which  the  fol- 
lowing is  an  illustration  : 

Case  XXVIII.  A  farmer,  thirty-six  years  of  age,  and  married 
for  fifteen  years,  consulted  me  in  April,  i8<So,  on  account  of  inability 
to  procreate  children.  The  preputial  orifice,  which  would  only 
admit  a  small  probe,  was  seated  upon  the  back  of  the  head  of  the 
penis,  so  that  the  meatus  was  completely  hidden  by  the  integu- 
ments. He  informed  me  not  only  that  the  urine,  but  that  the  semen, 
when  the  penis  became  flaccid,  converted  the  prepuce  into  a  sac, 
and  that  their  egress  had  to  be  facilitated  by  manipulation. 

^  Loc.  cit.,  p.  904.  2  Op.  cit.,  4th  Amer.  ed.,  p.  224, 

^  Proceedings  of  the  Phila.  Co.  Med.  Soc,  vol.  i.  p.  4. 
*  Gazette  de  Strasbourg,  No.  5,  1861. 


ATONIC    ASPERMATISM.  119 

In  a  similar  instance,  Blackwood'  circumcised  the  patient 
and  relieved  his  trouble.  In  the  case  of  Amussat,^  after  a 
barren  marriage  of  five  years'  duration,  the  removal  of  a 
very  tight  foreskin  was  crowned  with  success  ;  and  Bergh,^ 
in  the  case  of  a  man  twenty-one  years  of  age,  effected  a 
cure  in  three  weeks  by  circumcision. 

The  third  obstacle  to  the  proper  ejaculation  of  the  urine 
is  induration  of  the  corpora  cavernosa,  to  which  attention 
was  first  directed  a  century  and  a  quarter  ago  by  La 
Peyronie.'*  As  this  lesion  is  fully  considered  on  page  70, 
it  need  not  detain  us  in  this  connection. 


B.— ATONIC  ASPERMATISM. 

In  aspermatism  from  atony  or  loss  of  contractility  of  the 
muscles  of  the  seminal  vesicles,  ejaculatory  ducts,  prostate, 
and  urethra,  although  there  is  no  obstacle  to  the  ejacula- 
tion or  escape  of  the  seminal  fluid,  there  is  never  an 
emission  during  Intercourse  or  when  the  patient  is  awake ; 
but  nocturnal  pollutions  under  the  influence  of  lascivious 
dreams  are  not  infrequent,  and  are  accompanied  with  the 
usual  pleasurable  feelings.  Hence  the  sexual  act  is  never 
completed,  and  the  subject  has  to  abandon  his  efforts 
merely  from  a  sense  of  exhaustion.  In  organic  asper- 
matism, on  the  other  hand,  except  when  it  depends  upon 
congenital  lesions,  coition  is  finished  with  a  discharge 
which  is  prevented  from  escaping ;  or  if  the  ejaculatory 
ducts  are  closed  or  obstructed,  the  convulsive  movements 
are  experienced  with  the  ordinary  sensations. 

^  Loc.  cit.,  p.  5, 

*  Virchow-Hirsch's  Jahresbericht,  1866,  Bd.  ii.  p.  619, 

'  Loc.  cit.,  p.  37.  *  Mem.  de  I'Acad.  Roy.  de  Chir.,  1761,  vol.  i.  p.  428. 


120  ASPERMATISM. 

Roubaud^  attributes  this  form  of  aspermatism,  which  Is 
termed  idiopathic  by  Bergh/  paradoxical  by  Rheinstaedter,^ 
and  relative  by  other  observers,  to  spasmodic  contraction 
of  the  ejaculatory  ducts.  This  opinion  cannot  be  enter- 
tained, as  the  relaxation  of  the  spasm  should  be  followed 
by  the  escape  of  semen,  which  never  happens.  Schulz,"* 
Ultzmann,  Rosenthal,  Kocher,  and  other  observers  explain 
it  by  the  absence  of  excitability  in  the  lumbar  reflex  ejacu- 
latory centre  during  coition,  a  view  in  which  I  entirely 
concur.  In  many  examples,  the  general  symptoms  denote 
neurasthenia,  or  the  depressed  form  of  spinal  irritation, 
which  is  presumed  to  be  due  to  exhaustion  of  the  lumbar 
division  of  the  spinal  cord ;  and  from  the  fact  that  the 
affection  is  most  frequently  met  with  in  men  who  have 
been  addicted  to  masturbation  or  venereal  excesses,  or 
who  have  suffered  from  repeated  attacks  of  gonorrhoea,  a 
class  of  subjects  in  whom,  as  I  have  shown  in  the  chapter 
on  Impotence,  there  are,  as  a  rule,  inflammation  and  hyper- 
sesthesia  of  the  prostatic  portion  of  the  urethra,  I  believe 
that,  with  few  exceptions,  exploration  with  a  sound  or  bul- 
bous explorer  will  disclose  lesions  which  maintain,  and  are 
probably  the  cause  of,  the  abolished  excitability  of  the 
reflex  ejaculatory  centre.  In  the  majority  of  the  cases  of 
aspermatism,  other  than  of  the  organic  variety,  I  find  that 
the  urethra  was  not  examined,  and  that  hypersesthesia  was 
discovered  in  seven  out  of  nine  cases  in  which  an  instru- 
ment was  passed.  Hence,  exploration  of  the  canal  should 
never  be  omitted,  since  upon  its  condition  will  depend  the 
employment  of  the  proper  measures  for  the  relief  of  the 
trouble. 

^  Op.  cit.,  t.  i.  p.  248.  ^  Loc.  cit.,  p.  37. 

'  Deutsche  med.  Wochenschrift,  1879,  ^'^-  ^6,  p.  336. 
*  Ibid.,  1862,  pp.  769  and  787. 


ANESTHETIC    ASPERMATISM.  121 

These  statements  are  corroborated  by  the  following  cases 
from  my  private  practice : 

Case  XXIX.  A  merchant,  twenty-six  years  of  age,  had  mas- 
turbated from  his  thirteenth  to  his  twentieth  year,  and  erections 
were  provoked  by  merely  looking  at  a  woman,  and  by  other  slight 
causes.  At  the  age  of  twenty  he  had  his  first  connection,  but 
failed  to  ejaculate ;  and  repeated  subsequent  efforts  were  attended 
with  the  same  result.  His  erections  were  normal,  and  he  had  a 
nocturnal  emission,  with  the  usual  sensations,  about  once  every 
two  weeks.  The  entire  urethra  was  hyperssthetic,  and  the  pros- 
tatic portion  excessively  so ;  and  there  was  a  stricture,  calibre  24, 
at  six  inches  from  the  meatus. 

Case  XXX.  A  clerk,  thirty  years  of  age,  and  married  for  two 
years,  never  had  an  ejaculation  during  coition,  although  he  pro- 
longed the  act  until  fatigue  required  him  to  desist,  and  he  states 
that  ejaculation  failed  to  occur  during  masturbation,  which  he 
practised  up  to  the  age  of  fifteen.  He  had,  however,  a  nocturnal 
emission,  which  was  attended  with  a  pleasurable  sensation,  about 
once  a  week.  He  suffered  from  pain  in  the  back,  a  feeling  of  sore- 
ness over  the  vertex,  and  palpitation  of  the  heart ;  was  easily 
fatigued,  and  his  sleep  was  unrefreshing.  The  meatus  was  con- 
tracted, and  the  entire  urethra  was  very  sensitive  upon  exploration. 
The  meatus  was  laid  open  on  the  loth  of  June,  steel  bougies  were 
passed  at  stated  intervals,  their  size  being  gradually  increased,  and 
bromide  of  potassium  was  exhibited  internally.  On  the  27th  of 
August,  sexual  intercourse  was  completed  with  an  emission  ;  the 
symptoms  of  neurasthenia  had  disappeared  in  another  month;  and 
from  this  time  he  had  no  further  difficulty  in  intercourse. 


C— ANESTHETIC  ASPERMATISM. 

The  first  link  in  the  chain  of  the  phenomena  concerned 
in  the  act  of  ejaculation  is  the  conduction  of  the  sensory 


122  ASPERMATISM. 

Impressions  excited  by  the  friction  of  the  penis  against  the 
walls  of  the  vagina  to  the  lumbar  division  of  the  spinal 
cord.  If  the  sensory  nerves  fail  to  respond  to  the  ordinary 
stimulus,  reflex  contraction  of  the  ejaculatory  muscles  is 
prevented,  and  emission  is  rendered  impossible.  This 
variety  of  aspermatism,  which  may  be  termed  anaesthetic,  is 
not  common,  but  the  subjoined  illustrations  demonstrate 
the  possibility  of  its  occurrence. 

As  the  result  of  concussion  of  the  spine,  a  soldier  was 
affected  with  insensibility  of  the  prepuce,  of  the  gland  and 
skin  of  the  penis,  and  of  the  scrotum  to  such  a  degree  that 
pinching  and  pricking  with  pins  were  not  perceived  by  him. 
Abundant  nocturnal  pollutions  occurred  at  long  intervals  ; 
but  he  was  unable  to  ejaculate  on  coition  or  masturbation, 
the  latter  of  which  he  resorted  to  with  the  vain  hope  of  re- 
lieving priapism,  from  which  he  often  suffered,  and  which 
constituted  an  obstacle  to  the  discharge  of  the  urine.'  A 
gentleman,  aged  twenty-eight  years,  with  congenital  absence 
of  the  prepuce,  was  unable  to  complete  sexual  congress 
with  an  emission,  although  he  had  an  occasional  nocturnal 
pollution.  Concluding  that  the  trouble  arose  from  a  want 
of  excitability  in  the  nerves  of  the  gland  of  the  penis. 
Curling^  applied  the  acetum  cantharidis,  which  left  the  part 
in  a  very  sensitive  condition  ;  and  the  man  subsequently 
married,  and  seldom  failed  to  finish  intercourse  in  the 
normal  manner. 

In  the  second  case,  under  the  charge  of  the  same  ob- 
server,^  a  gentleman,  forty-four  years  of  age,  was  unable  to 
ejaculate  on  account  of  insensibilit}^  of  the  gland  and  skin 
of  the  penis.     Nearly  the   entire  back  of  the   organ  was 


^  Lallemand,  op.  cit.,  3d  Amer.  ed.,  p.  211. 

2  Op.  cit.,  4th  ed.,  p.  483.  ■''  Ibid.,  p.  485. 


PSYCHICAL    ASPERMATISM.  123 

covered  by  a  large,  indurated  scar,  and  the  prepuce  had 
disappeared,  the  lesions  having  been  due  to  syphilis. 

In  a  third  case,  under  the  charge  of  Curling,'  the  disten- 
tion of  the  glans  and  the  irritability  of  its  sensitive  nerves 
were  prevented  by  occlusion  of  the  meshes  of  the  corpus 
spongiosum  by  inflammatory  deposits,  through  which  the 
glans  did  not  enter  into  perfect  erection. 

Nonemission  may  also  be  due  to  obtunded  sensibility  of 
the  prostatic  portion  of  the  urethra,  which  Van  Buren  and 
Keyes^  regard  as  being  the  seat  of  pleasure  in  the  act  of 
copulation.  They  record  a  case  in  which  this  condition  was 
found  in  a  man,  thirty-six  years  of  age,  who  had  never  ex- 
perienced an  ejaculation  during  his  nine  years  of  married 
life,  although  he  had  had  nocturnal  emissions. 


D— PSYCHICAL   ASPERMATISM. 

That  the  reflex  movements  emanating  from  the  lumbar 
genital  centre  are  amenable  to  the  will  is  illustrated  by  the 
fact  that  many  men,  to  avoid  impregnation,  are  able  to 
retard  an  emission  until  the  penis  is  withdrawn  from  the 
vagina ;  and  the  restraining  action  of  the  cerebrum  is  also 
proved  by  two  curious  cases  of  atonic  aspermatism,  recorded 
by  Roubaud^  and  Hicquet,'*in  which  the  ejaculation  instantly 
ceased  if  the  patient  awakened  during  a  nocturnal  pollution. 
Other  men,  through  disgust,  suspicion  of  infidelity,  or  loss 
of  passion,  are  unable  to  complete  sexual  congress  with 
their  wives,  although   they    succeed  perfectly   with    other 

^  Op.  cit.,  4th  ed.,  p.  460. 

^  Genito-Urinary  Diseases,  with  Syphilis,  p.  466. 

^  Op.  cit.,  p.  244. 

*  Bull,  de  I'Acad.  Roy.  de  Med.  de  Belgique,  ser.  2,  t.  iv.  p.  482. 


124  ASPERMATISM. 

women.  Hence,  aspermatism  from  the  Inhibitory  action  of 
the  brain  over  the  centre  for  ejaculation  is  temporary  or 
relative,  emission  being  possible  under  some  circumstances 
and  impossible  under  others  ;  and  it  is  altogether  indepen- 
dent of  organic  lesions. 

Diagnosis. — The  determination  of  the  particular  form  of 
aspermatism  is  based  upon  the  history  of  the  case,  upon 
the  thorouofh  exploration  of  the  external  and  internal 
organs  of  generation,  upon  the  examination  of  the  urine, 
and  upon  the  conclusions  drawn  from  the  effects  of  the 
remedies  employed  for  its  relief.  As  these  points  have 
already  been  more  or  less  fully  considered,  little  need  be 
added  in  regard  to  them. 

The  existence  of  congenital  absence  or  obliteration  of 
the  ejaculatory  ducts  is  rendered  almost  certain  if  there 
has  never  been  an  emission  under  any  circumstances 
whatsoever,  if  the  urine  is  devoid  of  spermatozoa,  and  if 
there  is  no  history  of  antecedent  inflammation  or  injury. 
When,  on  the  other  hand,  the  urine  passed  after  coition 
contains  spermatozoa,  and  the  other  negative  signs  are 
present,  congenital  deviation  of  the  ducts  with  discharge 
of  the  semen  into  the  bladder  Is  a  perfectly  fair  inference. 

A  history  of  deeply  seated  abscess  of  the  perineum  or 
lithotomy  points  to  cicatricial  occlusion  of  the  ducts;  while 
the  detection  of  spermatozoa  in  the  urine  after  sexual  con- 
gress In  persons  who  have  suffered  from  perineal  abscess 
or  from  neglected  gonorrhoea  shows  that  there  is  acquired 
deviation  of  those  canals.  Obstruction  of  the  ejaculatory 
ducts  by  sympexlons  gives  rise  to  the  affection  termed 
spermatic  colic  by  Rellquet.  There  Is  always  reflex  con- 
traction or  loss  of  dilatabllity  of  the  bladder.  .This  makes 
Itself  known  by  difficult  and  very  frequent  urination,  and 


DIAGNOSIS.  125 

by  the  expulsion  of  the  last  drops,  which  are  liable  to  be 
bloody,  being  attended  with  lancinating-  pains  which  extend 
from  the  anus  to  the  extremity  of  the  penis.  The  subjects 
refrain  from  intercourse  because  excessive  sufferingr  is 
excited  at  the  moment  when  ejaculation  should  occur;  or 
is  even  induced  by  venereal  desires  or  by  commencing 
erection.  Exploration  through  the  rectum  discloses  a 
small,  circumscribed  tumor  in  the  region  of  the  prostate; 
and  if  the  latter  be  compressed  between  the  finger  and  a 
sound  in  the  urethra,  either  the  swellino-  will  at  once 
disappear,  and  the  instrument  be  covered  with  semisoft, 
grayish  masses  looking  like  bits  of  vermicelli  or  grains  of 
boiled  rice,  or  there  will  be  an  abundant  discharge  of  semen, 
which  contains  sympexions,  at  the  ejaculation  during  the 
first  coition  after  the  manipulations  ;  or  spermatozoa  and 
seminal  concretions  will  be  passed  at  the  succeeding  act 
of  micturition. 

In  aspermatism  from  stricture  of  the  urethra  the  patient 
has  nocturnal  emissions,  the  usual  convulsive  movements 
of  ejaculation  and  pleasurable  sensations  are  felt  during 
coition,  and  the  urine  passed  after  sexual  congress  contains 
spermatozoa.  The  diagnosis  is  confirmed  by  the  use  of 
the  exploratory  bougie,  to  which  sufficient  reference  is 
made  on  page  37.  When  the  trouble  arises  from  a  tight 
prepuce,  its  cause  is  obvious. 

Atonic  aspermatism  is  always  to  be  suspected  in  persons 
who  have  indulged  excessively  in  venery  or  in  masturba- 
tion, or  who  have  had  gonorrhoea  ;  in  those  who  suffer  from 
the  ordinary  symptoms  of  neurasthenia  ;  and  in  subjects 
who  ejaculate  under  the  influence  of  a  lascivious  dream. 
The  diagnosis  is  confirmed  by  the  existence  of  hyperaes- 
thesia  of  the  prostatic  urethra. 

The  anaesthetic  form  of  the  affection  is  denoted  by  the 


126  ASPERMATISM. 

loss  of  sensibility  of  the  gland  and  skin  of  the  prepuce  and 
penis  ;  and  nonejaculation  from  emotional  causes  is  readily- 
determined  by  the  history  of  the  case. 

Prognosis. — Aspermatism  from  spermatic  fistulse  and 
congenital  or  acquired  absence,  obliteration,  or  deviation  of 
the  ejaculatory  ducts  is  permanent,  and  nothing  is  to  be 
expected  from  treatment.  When  the  ducts  are  obstructed 
by  sympexions,  or  when  the  affection  is  referable  to  stric- 
ture of  the  urethra  or  phimosis,  a  cure  may  be  looked  for. 
The  prognosis  is  good  when  the  failure  to  ejaculate  depends 
upon  hyperaesthesia  of  the  prostatic  portion  of  the  urethra ; 
but  atonic  aspermatism  without  morbid  sensibility  of  that 
division  of  the  urethra  calls  for  a  certain  amount  of  reserve 
in  the  expression  of  an  opinion  ;  and  the  same  statement 
holds  good  for  the  anaesthetic  variety.  The  psychical  formx 
is  temporary  or  relative,  and  capable  of  correction. 

Treatment. — When  the  ejaculatory  ducts  are  obstructed, 
the  plan  proposed  and  successfully  practised  by  Reliquet  in 
two  cases  is  to  be  recommended.  A  sound  having  been 
introduced  into  the  bladder,  the  circumscribed  swelling  is 
emptied  by  counterpressure  with  the  finger  in  the  rectum. 
When  the  trouble  depends  upon  stricture  of  the  urethra, 
dilatation  or  internal  division  should  be  resorted  to  ;  and  if 
it  arises  from  phimosis,  circumcision  will  afford  prompt 
relief. 

When  the  atonic  variety  of  aspermatism  is  combined 
with  inflammation  and  hyperaesthesia  of  the  prostatic  ure- 
thra, the  measures  should  be  directed  to  subduing  the  latter 
before  attempts  are  made  to  restore  the  contractility  of  the 
muscles  concerned  in  the  act  of  ejaculation.  Hence,  the 
treatment  is  essentially  the  same  as  that  described  in  pages 


TREATMENT.  127 

41-52,   and   its   good   effects   are  well  illustrated  by  Case 
XXX. 

If,  on  the  other  hand,  the  prostatic  portion  of  the  urethra 
is  insensitive,  a  tonic  course  should  be  at  once  instituted. 
The  best  prospects  for  relief  are  held  out  by  quinine,  iron, 
and  strychnia,  internally,  cold  sitz-baths,'  and  galvanism,^ 
the  negative  catheter  pole  being  in  contact  with  the  veru- 
montanum,  while  the  anode  is  placed  over  the  lumbar  por- 
tion of  the  spine  or  the  perineum.  Instead  of  continuous, 
induced  currents^  may  be  employed,  as  in  the  instance  of 
Hicquet,"^  in  which  a  cure  was  effected  in  eight  days  after 
the  failure  of  the  remedies  advised  by  Roubaud.^  In  the 
case  recorded  by  the  latter  author,  under  the  idea  that  the 
affection  was  due  to  spasm  of.  the  ejaculatory  ducts,  normal 
coition  was  restored,  after  a  preliminary  venesection,  by  a 
pill  composed  of  assafoetida,  castoreum,  extract  of  opium, 
and  extract  of  hemlock,  and  by  sprinkling  the  vesicated 
surface  of  the  perineum  with  morphia.  In  another  example 
of  atonic  aspermatism  Hicquet^  succeeded  in  curing  his 
patient  in  ten  days  by  the  internal  exhibition  of  the  alco- 
holic extract  of  nux  vomica,  gradually  increased  from  two 
to  six  centigrammes  a  day. 

In  anaesthetic  aspermatism,  the  passage  of  the  faradic 
brush  over  the  penis,  the  anode  being  applied  to  the  spine, 
is  indicated,  with  the  view  to  restore  the  obtunded  or 
abolished  sensibility  of  the  nerves.  In  the  event  of  the 
failure  of  this  measure,  the  gland  of  the  penis  may  be  blis- 
tered with  some  prospect  of  success,  as  in  an  example  from 
the  practice  of  Curling.^ 

'  Consult  page  53.  ^  Consult  page  54. 

^  Consult  page  55.  *  Loc.  cit.,  p.  482. 

^  Op.  cit.,  p.  244.  ^  Loc.  cit.,  p.  492. 
■^  Op.  cit.,  p.  483. 


128  MISEMISSION. 

Aspermatism  from  disturbance  of  the  brain,  such  as  loss 
of  affection  for  or  repugnance  to  a  certain  woman,  is  hope- 
less, unless  the  subject  undergoes  a  change  of  sentiment. 
Being  entirely  emotional,  nothing  can  be  done  for  him  in 
the  way  of  medication. 


Sect.  IV.    Misemission. 

In  the  preceding  forms  of  sterility,  no  semen  whatsoever, 
or  unproductive  semen,  is  secreted  ;  or  there  is  failure  to 
ejaculate.  In  the  variety  under  consideration,  fertile  semen 
is  emitted,  but  it  is  not  deposited  in  the  upper  portion  of 
the  vagina ;  so  that  it  differs  from  aspermatism  from  me- 
chanical obstruction  in  that  the  secretion  has  an  outlet,  and 
does  not  regurgitate  into  the  bladder,  or  slowly  ooze  from 
the  urethra  when  the  erection  has  subsided.  Hence,  the 
term  misemission  is  employed  in  the  sense  that  the  ejacula- 
tion has  a  faulty  direction. 

The  most  common  causes  of  misemission  are  vices  of  con- 
formation of  the  nretJn^a.  Thus,  hypospadias  may  destroy 
the  capacity  for  procreation,  even  when  it  is  of  light  grade, 
as  in  two  cases  recorded  by  Kirsch  ;'  but  the  deformity  does 
not  usually  involve  sterility,  unless  the  opening  of  the 
urethra  is  situated  at  the  penoscrotal  junction  or  in  the 
perineum,  and  not  even  then,  as,  in  excepdonal  instances,^ 
the  posterior  wall  of  the  vagina  may  act  by  replacing  the 
deficient  inferior  wall  of  the  urethra,   thereby  permitting 

1  Wiener  med.  Presse,  1881,  p.  214. 

^  Morgagni,  Anat.  Path.,  1838,  t.  iii.  p.  73  ;  and  Casper,  op.  cit.,  p.  251. 


MALPOSITION    OF    THE    MEATUS.  129 

the  ejaculated  semen  to  reach  its  destination.  The  same 
statements  are  appHcable  to  epispadias,  and  to  fistulous 
openings  in  the  urethra,  the  result  of  stricture  or  injury. 
In  all  of  these  conditions  the  prognosis  is  unfavorable,  and 
the  treatment  is  most  unsatisfactory.  If  a  plastic  operation 
be  practised,  the  precaution  should  be  taken  to  make  a 
perineal  outlet  for  the  urine. 

Malposition  of  the  meatus,  through  which  the  semen  is 
voided  backward  and  downward,  or  to  one  side,  is  an  occa- 
sional cause  of  misemission,  and  is  usually  due  to  congenital 
or  acquired  shortening  of  the  frenum.  Guerlain'  has  re- 
ported the  case  of  a  man,  thirty-five  years  of  age,  in  which 
the  penis  was  almost  completely  rotated  from  left  to  right, 
so  that  the  dorsal  surface  reposed  on  the  scrotum,  and  the 
meatus  was  situated  on  the  side  of,  and  about  five-tenths 
of  an  inch  behind,  the  extremity  of  the  gland  ;  and  Guillon' 
met  with  a  case  in  which  the  meatus  opened  on  the  side  of 
the  gland,  and  in  which  the  stream  of  urine  described  almost 
a  right  angle  with  the  penis.  When  the  trouble  arises  from 
shortening  of  the  frenum,  the  proper  remedy  is  division  of 
that  structure.  In  the  case  of  Guillon,  excision  of  the 
pouch-like  walls  of  the  meatus  resulted  in  a  cure. 

1  Bull,  de  la  Soc.  Anat.,  ser.  2,  t.  iv.  p.  87. 

2  Gaz.  Med.  de  Paris,  1843,  P-  160. 


CHAPTER    III 


SPERMATORRHOEA. 


In  its  restricted  sense  spermatorrhoea  means  a  constant 
escape  of  seminal  fluid  without  erection  or  pleasurable 
sensation  ;  but  the  term,  in  a  sense  which  has  prolonged 
sanction,  is  employed  in  the  following  description  of  the 
affection  to  designate  all  the  varieties  of  involuntary  seminal 
losses  which  occur  beyond  the  limits  of  health,  and  it  is, 
therefore,  synonymous  with  seminal  incontinence.  Under 
no  circumstances  should  the  affection  be  regarded  merely 
as  a  ''functional  disorder  of  the  testes,"  since,  in  the  great 
majority  of  instances,  it  is  primarily  dependent  upon  and 
symptomatic  of  weakness  or  exhaustion  along  with  in- 
creased impressibility,  mobility,  or  excitability  of  the  genito- 
spinal  centre,  phenomena  usually  induced  and  perpetuated 
by  hyperaesthesia  of  the  nerves  which  supply  the  prostatic 
portion  of  the  urethra. 

Classification.  —  Seminal  incontinence  includes  three 
conditions  which  may  exist  separately,  or  pass  into  one 
another,  or  be  combined  in  the  advanced  stage  of  the  dis- 
order. These  conditions  constitute  the  following  varieties 
of  the  disease  : 

First.  Nocturnal  emissions  or  pollutions,  which  occur 
during  sleep,  and  are  generally  attended  with  an  erection, 
pleasurable  sensation,  and  an  erotic  dream. 

Second.     Diurnal  pollutions,  which  take  place  when  the 


NOCTURNAL    POLLUTIONS.  131 

subject  is  awake,  are  excited  by  slight  mechanical  or  psy- 
chical causes,  and  are  usually  accompanied  with  incomplete 
erection  and  diminished  sensation. 

Third.  Spermatorrhoea  in  the  strict  acceptation  of  the 
term,  or  a  slight  continual  flow  of  semen  from  the  urethra, 
without  erection  or  specific  sensation,  without  impure 
thouofhts,  or  duringf  urination  or  defecation.  To  avoid  con- 
fusion,  I  will  employ  the  term  spermorrhagia  to  indicate  this 
phase  of  the  affection. 

I.  Nocturnal  Pollutions. — Involuntary  nocturnal  semi- 
nal discharges  constitute  the  variety  of  the  affection  in 
regard  to  which  physicians  are  usually  consulted,  and  about 
which  not  a  little  ignorance  prevails,  as  they  are  natural  to 
all  men,  and  are  most  common  after  the  epoch  of  puberty, 
when  the  mind  is  more  or  less  taken  up  with  sexual  matters. 
Their  frequency  varies  in  accordance  with  a  great  many 
circumstances,  such  as  age,  climate,  habits,  constitution, 
temperament,  diet,  and  predisposition,  it  having  been  ob- 
served that  they  are  very  liable  to  occur  in  young  men  who 
were  affected  in  their  childhood  with  nocturnal  incontinence 
of  urine.  Their  frequency  also  varies  greatly  in  the  same 
individual ;  but  it  is  impossible  to  determine  the  healthy 
standard  merely  by  the  intervals  of  their  repetition,  since 
what  may  be  normal  in  one  person  may  be  morbid  in 
another.  In  a  general  way,  I  should  say  that  in  single  men 
who  lead  a  continent  life  and  possess  a  sound  nervous  sys- 
tem, emissions  at  intervals  of  two  weeks  are  indicative  of 
excellent  health.  In  such  persons  they  are  merely  reflex 
signs  of  fulness  or  distention  of  the  seminal  passages,  and 
constitute  an  inconvenience  of  ungratifled  sexual  instinct. 
Even  if  they  occur  several  times  a  week,  provided  they  are 
not   followed  by   symptoms  of  nervous   disorder,  they   are 


132  SPERMA'J'ORRHCEA. 

not  at  all  inconsistent  with  temporary  good  health,  as  is 
well  exemplified  by  the  following  striking  case,  under  my 
care  in  1882,  and  which  I  narrate  in  the  patient's  own 
language : 

Case  XXXI.  "  I  am  a  druggist,  single,  and  twenty-seven  years 
of  age.  I  commenced  masturbating  when  I  was  sixteen,  and  con- 
tinued the  practice  daily  until  I  was  twenty-one,  when  I  quit  it 
for  several  months,  and  the  nocturnal  emissions  began.  From  my 
twenty-first  to  my  twenty-sixth  year,  I  masturbated  three  or  four 
times  a  month,  and  would  stop  it  for  a  few  weeks,  and  again  resume 
it,  until  one  year  ago,  when  I  ceased  it  altogether.  For  the  past 
six  years  I  have  had  from  three  to  four  emissions  a  week,  at  times 
having  two  during  one  night.  They  were  always  accompanied  by 
a  voluptuous  dream.  I  have  two  or  three  erections  daily,  but  no 
emission  during  the  day,  and,  for  the  past  six  months,  I  .have 
noticed  that  a  few  drops  of  fluid  would  ooze  out  after  each  stool, 
especially  if  I  happened  to  strain.  I  have  never  had  connection 
with  a  female.  I  do  not  feel  badly  after  having  an  emission,  but 
get  up  ready  for  my  work.  I  have  a  good  appetite,  sleep  well,  am 
strong,  and  my  bowels  are  regular."  I  may  add  that  this  patient 
had  a  sensitive  prostatic  urethra,  and  that  I  circumcised  him,  and 
divided  a  stricture  seated  just  behind  the  meatus. 

Cases  like  the  preceding  are  exceptional,  but,  as  I  have 
already  intimated,  it  is  a  question  of  individual  tolerance 
and  constitution,  or  vulnerability  of  the  nervous  system. 
Hence  persons  who  consult  the  physician  in  regard  to 
involuntary  nocturnal  losses  should  be  informed  that  they 
are  natural  ;  and  they  should  be  impressed  with  the  fact 
that  the  emissions  need  not  awaken  concern  unless  they 
are  accompanied  with  unpleasant  effects,  or  they  have 
occurred  frequently  for  several  years,  as  in  the  latter  condi- 
tion it  will  only  require  a  little  longer  time  for  general 
symptoms  to  manifest  themselves. 


NOCTURNAL     POLLUTIONS.  133 

Nocturnal  pollutions  are  abnormal  or  pathological  when 
they  are  followed  by  headache,  backache,  slight  enfeeble- 
ment  of  the  functional  powers  of  the  brain,  mental  depres- 
sion, and  bodily  or  mental  languor  or  lassitude  ;  when  they 
occur  in  married  or  single  men  who  indulge  in  regular  in- 
tercourse  ;  when  they  take  place  without  erections  or 
dreams,  and  the  patient  is  only  made  aware  of  them  by 
the  stains  on  his  linen  ;  when  they  attend  or  follow  acute  or 
chronic  diseases  ;  when  they  are  associated  with  diurnal 
pollutions  or  spermorrhagia  ;  and  when  they  are  compli- 
cated by  one  of  the  varieties  of  impotence. 

All  of  the  preceding  conditions  are  very  liable  to  be 
attended  with  one  of  the  varieties  of  impotence,  which, 
indeed,  may  be  the  only  indication  that  the  emissions  are 
pathological  or  one  of  the  effects  of  impairment  of  the 
functions  of  the  lumbar  cord.  In  men  of  apparently  the 
same  amount  of  vigor  and  resistance,  and  in  whom  the 
pollutions  occur  with  equal  frequency,  the  associated  symp- 
toms of  nervous  exhaustion  var}^  very  much  in  degree,  or 
they  may  be  entirely  absent.  Thus,  in  Case  VI.,  page  29, 
in  which  the  emissions  occurred  from  one  to  five  times  a 
week,  the  signs  of  neurasthenia  were  pronounced  ;  while 
in  Case  XVI.,  page  39,  as  in  Case  XXXI.,  which  was  char- 
acterized by  an  excessive  number  of  pollutions,  there  was 
not  the  slightest  evidence  of  spinal  weakness.  In  Case  XL, 
page  ;^T),  there  were  no  general  symptoms  whatsoever; 
while  in  Case  XIV.,  page  35,  the  patient  was  a  hypochon- 
driac. In  both,  the  emissions  took  place  at  the  same  in- 
tervals. In  the  first  of  the  following  examples,  which  illus- 
trate the  same  point,  the  man  was  in  robust  health  ;  while 
in  the  second,  although  the  patient  evinced  no  outward  evi- 
dence of  impaired  health,  the   signs   of  myelasthenia  were 


184  SPERMATORRHOEA. 

marked.     They  are  selected  because   they  present  many 
points  in  common. 

Case  XXXII.  A  student  of  law,  aged  twenty-one,  had  mastur- 
bated from  his  eleventh  to  his  eighteenth  year,  and  has  suffered 
from  nocturnal  emissions  for  the  past  three  years,  on  an  average, 
three  times  a  week.  For  the  past  five  months  he  has  had  irrita- 
bility of  the  bladder,  and  feeble  erections  with  premature  ejacula- 
tions, for  which  he  sought  my  advice.  The  lips  of  the  meatus 
were  red  and  pouting,  and  I  detected  a  stricture,  calibre  13,  at  five 
inches  and  a  half  from  the  meatus,  along  with  great  sensitiveness 
from  that  point  as  far  as  the  neck  of  the  bladder. 

Case  XXXIII.  A  bookkeeper,  twenty-one  years  of  age,  has 
had  nocturnal  pollutions,  which  were  not  always  accompanied  by 
voluptuous  dreams,  three  times  a  week,  on  an  average,  for  four 
years  ;  and  he  had  masturbated  from  his  tenth  to  his  seventeenth 
year.  On  the  following  morning  he  felt  greatly  prostrated ;  and 
he  constantly  suffered  from  pains  in  the  back,  anorectal  region, 
and  top  of  the  head,  vertigo,  muscular  weakness  of  the  limbs,  and 
mental  lassitude  and  depression.  The  prostatic  urethra  was  ex- 
cessively sensitive,  but  there  was  no  stricture,  and  he  passed  pros- 
tatic fluid  when  the  bowels  were  constipated. 

2.  Diurnal  Pollutions. — Ejaculation  of  semen  when 
the  patient  is  awake  is  always  morbid,  and  indicates  a 
condition  of  irritable  weakness  of  the  genital  organs  and  of 
the  reflex  centres  which  preside  over  them.  In  the  lesser 
phase  of  this  variety  an  emission  is  due  to  slight  peripheral 
irritation,  provoked  by  friction  of  the  clothing,  crossing  of 
the  legs  repeated  several  times,  horseback  exercise,  driving 
over  rough  streets,  or  even  shaving,  or  combing  the  hair,' 
or  shampooing  the   head  f  while   in   the   more  aggravated 

^  Townsend,  Elements  of  the  Therapeutics,  vol.  ii.  p.  399.     London,  1799. 
^  Flint,  Principles  and  Practice  of  Medicine,  5th  ed.,  p.  938. 


DIURNAL    POLLUTIONS.  135 

form  the  ejaculation  is  induced  by  psychical  irritation,  as 
reading  libidinous  books,  the  sight  of  indecent  pictures, 
lascivious  ideas,  or  simply  looking  at  a  female.  In  the 
former  of  these  conditions  there  is  a  tolerable  erection,  but 
the  sensation  is  diminished  ;  in  the  latter  the  erection  is 
flabby,  or  the  penis  is  flaccid,  and  there  is  little  or  no  pleasure. 
In  five  cases  under  my  care  the  diurnal  pollutions  were 
due,  respectively,  to  thinking  of  women  in  one,  to  thinking 
of  women  and  looking  at  indecent  pictures  in  one,  to  driv- 
ing, bathing,  and  impure  thoughts  in  one,  to  horseback 
exercise  and  driving  in  one,  and  in  one,  the  history  of  which 
is  subjoined,  to  various  causes.  All  of  the  subjects  were 
rnasturbators  who  never  suffered  from  gonorrhoea  ;  all  were 
affected  with  neurasthenia  ;  and  all  had  hypersesthesia  of 
the  urethra  and  from  one  to  three  strictures.  Of  these  five 
cases,  the  following  is  noteworthy  : 

Case  XXXIV.  A  farmer,  forty- five  years  of  age,  masturbated 
daily  from  his  twelfth  to  his  twentieth  year,  and  less  frequently  to 
the  age  of  twenty-four.  On  ceasing  the  habit,  he  began  to  be 
troubled  with  nocturnal  emissions,  which,  up  to  the  date  of  his 
marriage,  six  years  before  he  consulted  me,  averaged  two  a  week, 
but  had  decreased  in  frequency  since  that  time.  The  erections 
were  always  weak,  and  ejaculation  premature,  occurring  frequently 
before  intromission.  Of  late  years  the  penis  has  been  so  sensitive 
that  the  mere  friction  of  the  clothing  in  walking  was  frequently 
sufficient  to  cause  an  erection  with  simultaneous  emission.  He 
suffered  from  pain  and  a  feeling  of  weight  in  the  perineum  and 
back,  muscular  weakness  of  the  limbs,  vertigo,  disturbed  sleep, 
constipation,  and  an  anxious  frame  of  mind  in  regard  to  his  con- 
dition, which  had  been  aggravated  by  his  wife,  an  amorous  woman, 
who  constantly  toyed  with  his  genital  organs.  An  elongated  pre- 
puce had  been  removed,  and  the  meatus  enlarged  eight  years 
before  I  saw  him. 

On  examination,  I  discovered  a  small  and  rigid  penis,  which  was 


136  SPERMATORRHOEA. 

SO  sensitive  to  the  touch  that  the  slightest  manipulation  preparatory 
to  exploring  the  urethra  was  followed  by  an  erection  and  an  emis- 
sion mixed  with  blood,  which  contained  only  a  few  spermatozoa. 
A  stricture,  calibre  20,  was  detected  two  inches  from  the  meatus, 
and  the  urethra  was  so  excessively  tender  that  the  bougie,  on 
reaching  its  prostatic  portion,  produced  lividity  of  the  face  and  an 
epileptoid  convulsion.  Emissions  subsequently  took  place  on  the 
passage  of  the  bougie;  but,  at  the  end  of  three  months,  under  ap- 
propriate treatment  and  division  of  the  stricture,  they  had  dis- 
appeared. 

3.  Spermorrhagia. — In  the  third  variety  of  the  affection, 
semen  is  constantly  discharged  without  the  occurrence  of 
the  orgasm  ;  and  its  passive  loss,  v^hich  is  associated  with 
dilatation  of  the  orifices  of  the  ejaculatory  ducts  from  atony 
of  their  muscular  fibres,  may  be  the  only  sign  of  seminal 
incontinence.  The  existence  of  this  condition  is  denied  by 
some  writers,  but  its  occurrence  cannot  be  questioned  ;  and 
Case  XXIL,  page  94,  in  which  the  fluid  brought  away  by 
the  bulbous  explorer  contained  motionless  spermatozoa, 
and  in  which  the  discharge  was  increased  by  straining  at 
stool,  and  by  toying  with  women  without  gratifying  the 
passions,  affords  a  capital  illustration  of  it. 

Under  this  category  should  be  included  the  condition  in 
which  the  semen  is  unconsciously  discharged  in  the  acts  of 
urination  and  defecation  ;  and  it  likewise  depends  upon 
irritable  weakness  of  the  seminal  vesicles  and  dilatation  with 
atony  of  the  ejaculatory  ducts.  While  in  the  majority  of 
instances,  the  fluid  pressed  out  of  the  urethra  in  these  ways 
is  derived  from  the  prostate,  the  microscope  discloses  that 
it  is  spermatic  in  a  certain  proportion  of  cases.  Some 
authors  are  sceptical  in  regard  to  the  passage  of  semen  with 
the  urine  ;  but  its  occurrence  is  attested,  apart  from  older 


SPERMORRH  AGIA,  137 

observations,  by  five  case  recorded  by  Beard,'  by  two  under 
the  care  of  Fiirbringer,"  by  two  reported  by  Black, ^  by 
Case  X.,  at  page  32,  and  by  the  following  additional  in- 
stances from  my  private  notes  : 

Case  XXXV.  A  clerk,  twenty-eight  years  of  age,  had  mastur- 
bated freely  for  ten  years,  and  for  the  past  two  years  had  diffi- 
culty in  acquiring  an  erection,  although  he  still  has  sexual  desire. 
He  is  greatly  depressed,  easily  fatigued,  incapable  of  prolonged 
mental  exertion,  and  has  a  woe-begone  expression.  There  is  a 
constant  slight  discharge  of  a  clear,  viscous  fluid  which  causes  the 
lips  of  the  meatus  to  adhere  during  the  night,  and  he  is  convinced 
that  the  urine  contained  semen.  I  found,  on  examination,  that  the 
urine  was  highly  acid,  and  contained  a  few  motionless  spermatozoa, 
pus  corpuscles,  and  crystals  of  oxalate  of  lime.  Strictures,  calibre 
22,  were  detected  at  one-eighth  of  an  inch  and  five  inches  from  the 
meatus,  and  the  prostatic  urethra  was  highly  sensitive. 

Case  XXXVI.  A  physician,  twenty-four  years  of  age,  who 
had  masturbated  from  his  eighth  to  his  sixteenth  year,  and  who 
had  never  contracted  gonorrhoea,  consulted  me  concerning  a  dis- 
charge which  for  one  year  had  escaped  from  the  urethra  at  stool 
and  at  the  end  of  micturition.  Minute  examination  of  the  fluid 
revealed  abundant  normal  spermatozoa,  and  strictures,  calibre  26, 
were  found  at  two  inches  and  a  half  and  five  inches  from  the 
meatus,  and  the  prostatic  urethra  was  extremely  sensitive.  He  had 
lost  flesh  and  strength,  was  incapacitated  for  mental  exertion,  was 
depressed  and  apathetic,  and  suffered  from  pain  in  the  back,  tin- 
nitus, and  constant  twitching  of  the  muscles.  Nocturnal  emissions 
occurred,  on  an  average,  at  intervals  of  eight  days. 

In  two  of  my  cases  dead  spermatozoa  were  detected  in 
the  urine,   thereby  constituting  a  condition  which  may  be 

'  Medical  Record,  1879,  PP-  73'  74-  ^^'^  55^;  and  1880,  pp.  507  and  508. 
^  Volkmann's  Vortrage,  No.  207,  1881,  pp.  1835  and  1856. 
^  London  Lancet,  1882,  vol.  ii.  pp.  618  and  655. 


138  SPERMATORRHCEA. 

called  azoospermorrhagia,  or  the  passive  loss  of  infertile 
semen,  while  in  the  third  case  living"  elements  were  numer- 
ous in  the  fluid  discharged  durino^  defecation  and  micturition. 
In  these  examples  the  orifices  of  the  ejaculatory  ducts  were 
open  and  atonic  from  the  localization  in  the  prostatic  ure- 
thra of  inflammation  induced  by  masturbation,  and  the 
subjects  were  neurasthenic. 

Fiirbringer'  has  recently  called  attention  to  the  fact  that 
spermorrhagia,  with  precisely  similar  local  lesions,  is  fre- 
quently induced  by  chronic  gonorrhoea,  the  semen  being 
expressed  from  the  seminal  vesicles  by  lifting  weights, 
coughing,  and  sneezing,  as  well  as  by  straining  at  stool  or 
in  passing  water,  or  by  any  other  cause  which  brings  about 
increased  intraabdominal  pressure.  Excluding  all  cases  in 
which  semen  might  be  accidentally  mixed  with  the  urine, 
Fiirbringer  has  found  spermatozoa,  sometimes  in  large 
numbers,  in  the  urine  of  twenty-five  out  of  one  hundred 
and  forty  cases  of  chronic  gonorrhoea.  This  "latent"  or 
false  spermorrhagia  has  nothing  in  common  with  neuras- 
thenic spermorrhagia,  save  the  local  lesions  ;  it  is  not  com- 
plicated by  impotence  or  sterility,  nor  is  it  associated  with 
disorders  of  the  general  health. 

Clinical  History. — Any  one  of  the  three  forms  of 
spermatorrhoea  may  exist  separately,  but  they  gradually 
pass  into  each  other,  and  are  variously  intermixed  in  the 
advanced  grade  of  the  affection.  When  the  case  goes  on 
from  bad  to  worse,  it  usually  pursues  the  following  course, 
in  consequence  of  the  increase  in  the  mobility  of  the  ejacu- 
latory centre,  and  of  the  advancing  exhaustion  of  the  entire 
nervous  system.     At  first,  abnormal  frequency  of  the  noc- 

^  Deutsche  medicinische  Wochenschrift,  No.  42,  1886,  p.  730. 


CLINICAL    HISTORY.  139 

turnal  pollutions  is  associated  with  backache,  headache,  a 
sense  of  painful  muscular  fatigue,  and  slight  paresis  of  the 
brain,  as  indicated  by  incapacity  for  any  sustained  mental 
effort.  With  the  increase  in  the  number  of  the  emissions, 
the  patient  discovers  that  erections  are  becoming  insuffi- 
cient, and  that  ejaculation  on  coition  is  precipitate  ;  and  the 
general  symptoms  are  aggravated  by  the  addition  of  dul- 
ness  of  perception,  impairment  of  memory,  vertigo,  mental 
dejection,  weakness  of  vision,  trembling  of  the  limbs,  palpi- 
tation of  the  heart,  shortness  of  breath,  a  sense  of  oppres- 
sion in  the  chest,  flatulence,  constipation,  and  other  dyspeptic 
signs.  Diurnal  pollutions  from  slight  mechanical  or  psy- 
chical causes  are  now  superadded,  and  the  emissions  occur 
with  little  or  no  erection  or  pleasurable  sensation,  or  even 
when  the  penis  is  flaccid  ;  and  intercourse  is  impracticable, 
either  from  flabby  erection  or  from  anticipating  ejaculation. 
The  general  symptoms  also  are  more  serious.  The  patient 
is  liable  to  brood  over  his  assumed  lost  virility,  and  the 
mental  depression  verges  upon  or  passes  into  a  condition 
of  sexual  hypochondrism.  His  gait  is  unsteady ;  he  is 
subject  to  wandering  neuralgic  and  rheumatoid  pains  ;  the 
hands  and  feet  are  habitually  cold  ;  he  passes  restless  or 
sleepless  nights  ;  shuns  society  ;  fears  to  look  one  in  the 
face  ;  is  utterly  incapacitated  for  mental  or  physical  exer- 
tion ;  and  thinks  of  nothing  but  his  sexual  organs.  With 
the  still  further  increase  of  the  irritable  weakness  of  the 
genitalia  and  nervous  system,  the  semen  constantly  oozes 
out  of  the  urethra,  and  its  discharge  is  augmented  during 
defecation  and  micturition.  The  man  is  converted  into  a 
confirmed  hypochondriac,  and  if  he  comes  from  an  insane 
family,  he  lapses  into  insanity,  not,  however,  because  of  the 
seminal  losses,  but  because  of  the  disturbances  of  the 
nervous   system  which  lead  to   the   emissions.     A   person 


140  SPERM  ATORRHCEA. 

who  has  inherited  a  tendency  to  insanity,  epilepsy,  ataxia, 
or  other  nervous  disorders,  may,  therefore,  bring  on  those 
affections,  the  first  Hnk  in  the  chain  being  functional  troubles 
of  the  nervous  centres,  which  gradually  pass  into  organic 
disease,  and  are  caused,  according  to  my  observations,  in 
rather  more  than  nine-tenths  of  all  cases,  by  masturbation. 

Of  the  general  symptoms  which  are  associated  with 
abnormal  seminal  losses,  and  which  indicate  more  or  less 
complete  exhaustion  of  the  brain  and  spinal  cord,  an 
analysis  of  one  hundred  and  seventy-five  cases,  of  which  I 
have  notes,  indicates  the  following  interesting  facts  in  re- 
gard to  their  importance  and  relative  frequency.  There 
was  an  anxious  or  depressed  condition  of  the  mind  in 
seventy-two ;  constant  dwelling  upon  sexual  matters  in 
seventy-two ;  hypochondrism  in  fourteen ;  mental  dejec- 
tion after  intercourse  or  emission  in  sixty ;  impairment  of 
memory  in  fifty-five  ;  incapacity  for  prolonged  mental  exer- 
tion in  sixty-eight ;  headache  in  sixty-nine ;  vertigo  in 
thirty;  broken  sleep  in  fifteen;  insomnia  in  six;  drowsiness 
in  eleven  ;  irascibility  in  two  ;  asthenopia,  or  muscae  voli- 
tantes,  in  thirty-one ;  noises  in  the  ears  in  twenty-six ; 
muscular  weakness  of  the  limbs  and  fatigue  in  one  hundred 
and  eighteen  ;  trembling  of  the  limbs  in  ten  ;  temporary 
reflex  paraplegia  in  one ;  pain  in  the  back  in  ninety-five ; 
oppressed  breathing  in  seven  ;  pain  in  the  chest  in  three  ; 
constipation  in  sixty-one;  dyspepsia  in  forty;  palpitation  of 
the  heart  in  twenty-six ;  subjective  sensations  of  cold  in 
eleven,  and  of  heat  in  four  ;  loss  of  flesh  in  nine  ;  and  pallor 
of  the  face  in  fifteen. 

It  will  thus  be  perceived  that  constant  occupation  of  the 
mind  with  the  sexual  functions,  mental  dejection,  impair- 
ment of  the  memory,  incapacity  for  mental  work,  headache, 
vertigo,  muscular  weakness  of  the  limbs,  pain  in  the  back, 


ETIOLOGY.  141 

noises  in  the  ears,  and  irritability  of  the  eyes,  constitute 
the  most  common  of  the  disturbances  of  the  cerebrospinal 
axis  and  of  the  special  senses  ;  while,  of  the  phenomena 
referable  to  the  circulatory,  respiratory,  digestive,  vaso- 
motor, and  nutritive  systems,  palpitation  of  the  heart,  op- 
pression of  breathing-,  constipation,  indigestion,  chilliness, 
a  feeling  of  elevated  temperature,  pallor,  and  emaciation, 
are  the  most  frequent.  In  six  cases  the  presence  of  dark 
spaces  under  the  eyes  formed  the  subject  of  grave  appre- 
hension. 

A  further  analysis  of  the  one  hundred  and  seventy-five 
cases  shows  that  certain  local  sio-ns  are  connected  with 
seminal  incontinence.  There  was  feebleness  of  erection 
with  premature  ejaculation  in  thirty-eight ;  irritable  weak- 
ness in  twenty-nine;  total  failure  of  erection  in  ten;  elonga- 
tion of  the  prepuce  in  thirty-nine;  relaxation  of  the  scrotum 
in  nineteen;  irritable  testis  in  nine;  varicocele  in  six; 
hemorrhoids  in  five  ;  coldness  of  the  genitalia  in  eight ;  a 
feeling  of  heat  in  the  genitalia  in  three  ;  painful  ejaculation 
on  intercourse  in  three ;  bloody  ejaculation  in  one ;  and 
irritability  of  the  bladder  in  eight.  In  fourteen  examina- 
tions of  the  semen  furnished  by  patients  suffering  from 
an  aggravated  form  of  the  malady,  I  found  that  fluid  to  be 
water}-,  and  that  in  four  the  spermatozoa  were  small,  mo- 
tionless, and  variously  deformed,  and,  therefore,  incapable 
of  impregnating  the  ovum.  As  the  changes  which  the 
semen  undergoes  in  spinal  exhaustion  have  been  so  fully 
considered  in  the  section  on  azoospermism,  they  need  only 
be  referred  to  in  this  connection. 

Etiology. — Spermatorrhoea  is  not  a  distinct  affection, 
but  one  of  many  symptoms  of  general  and  local  lesions,  or 
of   both   combined.      In   the  vast   majority  of  instances  it 


142  SPERMATORRHCEA. 

must  be  regarded  as  a  motor  neurosis,  or  a  functional 
derangement  of  the  nervous  S3^stem,  which  is  indicated  by 
increased  susceptibiHty  of  the  brain  and  cord,  or  feebleness 
of  their  powers  of  resistance  to  acts  which  in  healthy  per- 
sons would  not  be  productive  of  evil  consequences.  Like 
other  neuroses,  it  may  be  the  result  of  congenital  predis- 
position, when  it  is  liable  to  be  observed  in  several  mem- 
bers of  the  same  family  through  several  generations. 
Under  these  circumstances,  the  subject  is  of  a  nervous, 
excitable,  or  irritable  temperament ;  and  he  probably  suf- 
fered during  his  infancy  from  nocturnal  incontinence  of 
urine,  as  was  first  pointed  out  by  Trousseau,"  of  which  the 
following  example  is  a  marked  illustration  : 

Case  XXXVII.  A  physician,  fifty  years  of  age,  consulted  me, 
March  14,  188 1,  on  account  of  nervous  exhaustion,  seminal  losses, 
and  dread  of  impotence.  Up  to  his  tenth  year  he  was  troubled 
with  nocturnal  enuresis.  He  was  a  close  student  at  college  ;  and 
at  the  age  of  eighteen  began  to  have  nocturnal  emissions,  and  his 
mind  dwelt  constantly  on  sexual  ideas  ;  but  he  never  masturbated. 
Up  to  the  time  he  saw  me,  or  for  thirty-two  years,  the  emissions 
varied  from  one  to  three  a  week  ;  but  he  did  not  evince  any  special 
signs  of  neurasthenia  for  several  years  after  their  commencement, 
when  he  observed  that  he  was  constantly  drowsy,  and  that  he  was 
very  restless,  particularly  in  crowded  assemblies  and  at  social  enter- 
tainments. He  soon  became  easily  fatigued,  and  was  incapable  of 
bodily  exertion,  and  his  brain  was  unequal  to  prolonged  work. 
Three  years  ago  he  abandoned  the  practice  of  his  profession,  and 
during  a  visit  to  Europe,  in  the  summer  of  1880,  he  had  a  mild 
attack  of  reflex  paraplegia,  which  followed  a  sudden  rush  of  blood 
to  the  head.  He  never  had  sexual  intercourse.  He  has  an  erec- 
tion nearly  every  morning,  but  the  gland  of  the  penis  is  rather 
flabby,  and  he  notices  that  the  lips  of  the  meatus  are  glued  together 

'  Op.  cit.,  t.  ii.  p.  636. 


ETIOLOGY.  148 

by  a  slight  gleety  discharge.  The  prepuce  is  somewhat  long ; 
there  is  a  stricture,  calibre  22,  one-third  of  an  inch  behind  the 
meatus;  the  prostatic  urethra  is  highly  sensitive;  there  is  a  large 
varicocele  of  the  left  side;  and  there  is  a  tendency  to  irritability 
of  the  bladder. 

Among  the  predisposing-  causes  may  be  mentioned  erotic 
ideas.  When  constantly  and  involuntarily  indulged  in, 
even  when  the  patient  does  not  practise  natural  or  un- 
natural acts,  as  in  the  preceding  case,  they  constitute  a 
pov\^erful  factor  in  the  production  of  irritation  of  the  genital 
organs  and  of  reflex  impressibility  of  the  centres  which 
preside  over  them. 

Seminal  incontinence  is  usually  acquired,  and  is  due  in 
the  great  majority  of  instances  to  masturbation.  Thus  of 
the  one  hundred  and  seventy-five  cases  of  which  I  have  a 
record,  in  only  one  was  it  the  result  of  an  inherited  predis- 
position. Of  the  remaining  examples,  in  one  hundred  and 
fifty-three  it  was  traceable  to  onanism ;  in  seven  it  arose  from 
gonorrhoea ;  in  eleven  it  was  met  with  in  men  who  had 
masturbated,  suffered  from  gonorrhoea,  and  had  indulged 
their  propensities  in  various  ways  ;  in  one  it  was  due  to 
toying  with  women  ;  and  in  three  the  cause  was  obscure. 
One  hundred  and  fifty-four  were  single,  eighteen  were 
married,  and  three  were  widowers.  Twenty-two  cases  oc- 
curred before  the  age  of  twenty ;  one  hundred  and  three 
between  twenty  and  thirty  ;  thirty-six  between  thirty  and 
forty ;  and  fourteen  between  forty  and  fifty-four.  All  of 
the  married  men  were  given  to  sexual  excesses  ;  and 
although  four  stated  that  they  were  not  addicted  to  mas- 
turbation early  in  life,  I  believe  that  marital  sexual  excess 
is  generally  the  natural  result  of  a  previously  vicious  habit. 
In  only  one  case  of  this  class  did  the  emissions  come  on 


144  SPERMATORRHCEA. 

subsequent  to  marriage.  In  the  remaining  seventeen, 
they  were  present  both  before  and  after  marriage.  Of 
the  one  hundred  and  fifty-three  masturbators,  all  except 
twenty-six  had  one  or  more  strictures  ;  and  the  remaining 
twenty-two  patients  were,  with  a  single  exception,  affected 
in  the  same  way.  In  only  eleven  cases  was  decided  hyper- 
aesthesia  of  the  urethra  absent;  so  that  this  condition  is 
rather  less  frequent  in  case-s  of  spermatorrhoea  than  in 
cases  of  impotence,  in  which,  as  has  been  pointed  out  on 
page  2  1,  it  was  wanting  in  twelve  cases  out  of  two  hundred 
and  sixty. 

Under  the  influence  of  erotic  ideas,  masturbation,  sexual 
excesses,  or  unsatisfied  sexual  excitement  produced  by  toy- 
ing with  females,  exaggerated  irritability  of  the  genital 
organs  is  induced,  and  is  soon  followed  by  chronic  or  sub- 
acute inflammation  and  hypersesthesia  of  the  prostatic  por- 
tion of  the  urethra,  which  culminate,  in  bad  cases,  or  in 
those  characterized  by  diurnal  pollutions  and  spermor- 
rhapfia,  in  dilatation  and  relaxation  of  the  orifices  of  the 
ejaculatory  ducts.  As  the  natural  result  of  their  constant 
excitability,  the  nerves  distributed  to  the  prostatic  urethra 
are  alive  to  the  slightest  impressions.  This  condition  in- 
duces increased  mobility  or  irritability  of  the  reflex  cere- 
bral and  spinal  genital  centres,  through  which  the  motor 
nerves  which  supply  the  ejaculatory  apparatus  are 
thrown  into  action,  and  an  emission  follows.  This,  it 
seems  to  me,  is  the  rational  explanation  of  seminal  in- 
continence. 

Involuntary  seminal  losses  are  also  met  with  during  con- 
valescence from  or  during  the  progress  of  certain  acute  and 
chronic  diseases  which  are  characterized  by  disturbances, 
or  exhaustion,   of  the   nervous  system.     Thus,   it  may  be 


ETIOLOGY.  145 

symptomatic  of  variola  or  phthisis,'  typhus,^  progressive 
muscular  atrophy  and  commencing  bulbar  paralysis, ^  of 
paraplegia,'*  and  of  locomotor  ataxia, ^  in  the  last  of  which 
affections  Hammond^  has  recorded  an  example  of  eight 
nocturnal  pollutions  in  a  night.  Chronic  alcoholism  also 
predisposes  to  their  occurrence  ;  and  MitchelP  describes  a 
case  in  which  they  seemed  to  be  due  to  the  habitual  use 
of  opium.  I  have  myself  met  with  a  case  in  which  the 
emissions  set  in  during  an  attack  of  typhoid  fever  ;  but  as 
the  man  had  a  phimosis,  and  had  been  a  masturbator,  I  am 
inclined  to  believe  that  his  illness  served  simply  to  increase 
a  preexisting  weak  condition  of  the  spinal  genital  centre. 
From  the  great  rarity  with  which  nocturnal  emissions  have 
been  observed  in  the  diseases  mentioned  above,  I  have 
no  doubt  that  urethral  lesions  were  present  in  the  cases 
here  cited. 

Of  the  local  causes  of  spermatorrhoea,  by  far  the  most 
common  are  hyperaesthesia  and  chronic  inflammation  of 
the  prostatic  portion  of  the  urethra,  which  are  generally 
induced  by  masturbation  ;  and  these  morbid  conditions  are 
just  as  important  in  its  production  as  they  are  in  the  causa- 
tion of  impotence.  In  the  vast  majority  of  cases  they  con- 
stitute the  original  source  of  the  trouble,  and  tend  not  only 
to  excite  reflex  emissions,  but  also  to  maintain  the  disorder 
by  keeping  the  mind  occupied  with  sexual  matters.  Even 
in  cases  in  which  the  affection  would  seem  to  depend  upon 

'   Curschmann,  loc.  cit.,  p.  867. 
'■^  Nowatschok,  Wiener  med.  Presse,  1879,  P-  1067. 
^  Stephanides,  ibid.,  p.  9^13. 

*  Roberts,  Canada  Med.  Record,  vol.  vii.  p.  253. 

'"  Erb,  op.  cit.,  pp.  543  and  585;  Trousseau,  op.  cit.,  p.  510;  and  Topinard, 
De  I'Ataxie  Locomotrice,  p.  171. 

^  Treatise  on  the  Diseases  of  the  Nervous  System,  6th  ed.,  p.  593. 
'  Amer.  Med.  Monthly,  vol.  xv.  p.  285. 

10 


146  SPERMATORRHOEA. 

Other  local  lesions,  they  are  almost  invariably  present,  so 
that  associated  disorders  of  the  penis,  the  urethra,  or  the 
rectum  merely  act  by  intensifying  them.  In  a  few  cases  it 
is  true  that  the  hyperaesthesia  is  not  marked,  and  that  other 
abnormal  states,  as  a  congenital  contraction  of  the  meatus, 
are  sufficient  to  excite  reflex  contraction  of  the  seminal 
vesicles  ;  but  in  these  instances  it  is  scarcely  possible  that 
local  conditions  would  induce  the  trouble  in  persons  who 
were  not  predisposed  to  it.  Hence,  I  think  that  no  case 
should  be  treated  without  a  preliminary  examination  of  the 
urethra,  which  seems  to  be  omitted  by  physicians  in  gen- 
eral, and  by  many  surgeons. 

Of  the  local  exciting  causes  phimosis,  in  the  form  of 
redundancy  of  the  prepuce,  is  probably  one  of  the  most 
common,  and  acts  as  a  source  of  reflex  irritation  by  keeping 
the  gland  moist,  or  by  retaining  the  smegma.  Not  only  is 
the  prepuce  elongated,  but  in  many  cases  it  will  be  found 
to  constrict  the  gland  when  the  penis  is  erect,  a  point  which 
should  always  be  looked  into,  as  it  has  an  important  bear- 
ing upon  the  treatment.  Herpes  of  the  prepuce,  which  is 
far  less  frequently  met  with  than  the  preceding  condition, 
is  another  cause :  so  also  is  congenital  shortness  of  the 
frenum,  as  in  a  case  recorded  by  Heulard  Darcy.' 

Of  the  conditions  which  relate  to  the  urethra,  the  most 
important  are  congenital  narrowing  of  the  meatus,^  which 
I  have  seen  in  sixteen  cases,  and  organic  stricture,  seated 
near  the  orifice,  of  which  I  have  met  with  many  examples. 
ZeissP  has  quite  recently  declared  that  spasmodic  stricture 
is  a  cause  of  very  frequent  pollutions.      In  a  unique  case 

1  Virchow-Hirsch's  Jahresbericht,  1866,  Bd.  ii.  p.  169. 
''■  Hicquet,  Canstatt's  Jahresbericht,  i860,  Bd.  iii.  p.  225. 
•'*  Med.  News  and  Library,  January,  1881,  p.  41. 


ETIOLOGY.  147 

recorded  by  Genaudet,'  the  removal  of  a  polyp  from  the 
prostatic  portion  of  the  urethra  was  followed  by  the  cessa- 
tion of  the  nocturnal  emissions. 

Acute  inflammation  of  the  seminal  vesicles  is  attended 
with  frequent  and  painful,  and  it  may  be  with  bloody, 
pollutions.  In  an  instance  of  chronic  inflammation  of  these 
bodies  under  my  care,  the  discharge  was  usually  of  a 
yellowish  tint  from  the  admixture  of  pus,  and  decidedly 
bloody  when  the  pollutions  followed  each  other  in  quick 
succession.  In  cases  of  this  description  the  seminal  losses 
are  due  to  hyperaesthesia  of  the  mucous  membrane  of  the 
vesicles,  so  that  the  trouble  is  analogous  to  incontinence 
of  urine  from  morbid  sensibility  of  the  lining  membrane 
of  the  bladder.  Liegeois^  states  that  epididymitis  is  a 
fruitful  source  of  nocturnal  emissions. 

Among  other  exciting  causes  of  spermatorrhoea  may 
be  mentioned  diseases  of  the  rectum  and  anus,  as  piles, 
ascarides,  fissures,  pruritus,  and  painful  eruptions;  and 
Perrin^  has  recorded  a  case  in  which  nocturnal  pollutions 
were  induced  by  the  cauterization  of  internal  hemorrhoids. 
As  the  rectum  and  anus  are  supplied  by  the  same  nerves 
as  are  distributed  to  the  genitalia,  it  is  not  surprising  that 
the  reflex  ejaculatory  centre  should  respond  to  an  impulse 
transmitted  from  them.  The  same  statement  is  true  of 
certain  aflections  of  the  bladder.  Habitual  constipation 
may  also  excite  emissions  through  the  increased  intra- 
abdominal pressure  exerted  upon  the  seminal  vesicles 
during  the  evacuation  of  hardened  feces ;  but  this  is 
observed  only  when  the  orifices  of  the  ejaculatory  ducts 
are  dilated  and  paralyzed.     The  fluid  which  escapes  from 

^  Virchow-Hirsch's  Jahresbericht,  ut  supra,  p.  163. 

^  Loc.  cit.,  p.  512. 

^  Canstatt's  Jahresbericht,  1857,  p.  301. 


148  SPERMATORRHCEA. 

the  urethra  of  heakhy  men,  under  these  circumstances,  is 
not  seminal,  but  it  is  usually  derived  from  the  prostate. 

Anatomical  Characters.  —  The  morbid  appearances 
which  belong  to  spermatorrhoea  in  its  early  stage  are  utterly 
unknown  so  far  as  their  verification  by  post-mortem  exami- 
nation is  concerned.  That  the  exaltation  of  the  sensibility 
of  the  urethra  depends  upon  subacute  or  chronic  inflamma- 
tion of  its  mucous  membrane,  particularly  in  the  region  of 
the  verumontanum,  is  rendered  certain  by  the  concomitant 
local  symptoms,  by  exploration  with  the  endoscope  and  the 
sound,  aided  by  the  finger  in  the  rectum,  and  by  the  results 
of  treatment.  In  seven  aggravated  cases,  of  which  two 
are  recorded  by  Lallemand,'  one  is  narrated  by  Curling,^ 
and  four  are  collated  by  Kaula,^  there  was  a  stricture  in 
four,  injection  of  the  mucous  membrane  of  the  deep  por- 
tion of  the  urethra  in  two,  dilatation  of  the  orifices  of  the 
ejaculatory  ducts  in  six,  combined  with  excoriation  in  two, 
ulceration  in  two,  and  enlargement  of  the  canals  themselves 
in  one,  suppuration  of  the  prostate  in  four,  suppuration 
of  the  seminal  vesicles  in  three,  and  chronic  inflammation 
of  those  bodies  in  two. 

So  far  as  I  am  aware,  there  have  been  no  examinations 
of  the  nervous  centres  connected  with  the  genital  organs 
in  spermatorrhoea,  so  that  it  is  impossible  to  say  whether 
they  are  the  seat  of  structural  lesions.  In  a  case  of  para- 
plegia induced  by  sexual  excesses,  however,  Sir  William 
Gulk  was  unable  to  detect  the  slightest  chang-e  in  the  cord. 
The   common   view,    that   the   cells  which   minister   to   the 

'   0|).  cit.,  Phila.,  1858,  pp.  37  and  42. 

^  Op.  cit.,  4th  ed.,  p.  492. 

^  Dela  Spermatorihee,  These  de  Paris,  1846,  pp.  167-173. 

*  Guy's  Hosp.  Reports,  1858,  p.  175. 


DIAGNOSIS.  149 

functions  of  the  cord  are  completely  exhausted  is,  therefore, 
probably  correct. 

Diagnosis. — The  only  mode  of  determining  whether  the 
fluid  which  constantly  moistens  the  urethra,  is  discharged  at 
stool  or  with  the  urine,  or  is  brought  away  by  the  bulb  of 
the  explorer,  is  seminal  in  its  character,  is  to  examine  it 
under  the  microscope  with  a  power  of  about  four  hundred 
diameters,  with  the  view  of  discovering  spermatozoa. 
Should  they  be  found,  there  need  be  no  doubt  as  to  its  true 
nature  ;  but  it  must  be  remembered  that  their  absence  is 
not  an  evidence  that  the  case  is  not  one  of  spermatorrhoea, 
since,  as  I  showed  at  page  90,  the  exhausted  sexual  appa- 
ratus in  aggravated  examples  furnishes  a  water)'  fluid  which 
may  be  devoid  of  fertilizing  elements.  Under  these  cir- 
cumstances the  history  of  the  case,  and  the  associated 
general  symptoms  are  to  be  considered  in  framing  the  diag- 
nosis ;  and  this  is  particularly  true  of  the  examples  in  which 
a  discharge  is  expressed  at  stool,  and  which  in  the  majority 
of  instances  is  merely  the  secretion  of  the  prostate  gland. 
Under  the  microscope  the  thin,  more  or  less  milky  prostatic 
fluid  will  be  found  to  contain  cylinder  epithelium,  number- 
less colorless  and  refractino-  oranules  of  lecithin,  one-half 
the  diameter  of  a  red  blood-corpuscle,  and  minute  concen- 
tric amyloid  concretions  ;  and  spermatic  cr)'stals  will  soon 
make  their  appearance  on  the  slide  ;  while  the  thin,  trans- 
parent, azoospermous  semen  contains  cylinder  epithelium, 
and  probably  epithelium  which  has  undergone  fatty  or  col- 
loid degeneration,  a  few  lymph  corpuscles,  and  abundance 
of  fatt)'  detritus,  and  possibly  a  few  small  shining  bodies 
which  are  the  remains  of  badly  evolved  spermatozoa. 

In  the  absence  of  minute  examination,  the   rule  may  be 
framed  that  the  dischargre  which  occurs  durine  defecation 


160  SPERMATORRHCEA. 

in  persons  who  are  laboring  merely  under  too  frequent 
nocturnal  pollutions  is  an  evidence  of  coexisting  prostator- 
rhoea  ;  while  the  flocculent  sediment  contained  in  the  urine, 
and  the  discharge  at  stool  in  persons  who  are  suffering  from 
nocturnal  and  diurnal  pollutions,  and  a  slight  continued 
discharge  from  the  urethra  represent  semen.  In  the  last 
case,  the  assumption  that  the  orifices  of  the  ejaculatory 
ducts  are  relaxed  will  generally  be  correct,  and  it  will  be 
strengthened  if  the  patient  is  impotent. 

Prognosis. — According  to  my  experience,  the  prognosis 
of  seminal  incontinence  is  far  from  being  so  unfavorable  as 
man)'  writers  would  lead  one  to  believe.  In  regard  to  in- 
creased frequency  of  nocturnal  emissions,  the  phase  of  the 
affection  about  which  the  physician  is  most  frequently  con- 
sulted, I  have  no  hesitation  in  declaring  that  it  yields  readily 
to  treatment,  particularly  when  it  is  caused  or  kept  up  by 
appreciable  local  lesions,  such  as  hyperaesthesia  of  the  pros- 
tatic urethra,  stricture,  or  hemorrhoids.  The  subject  of 
Case  XVI.,  page  39,  is  an  excellent  and  not  uncommon 
illustration  of  the  truth  of  this  statement.  The  pollutions 
had  been  excessive  for  two  years,  and  were  complicated  by 
prostatorrhoea  and  a  mild  grade  of  impotence.  On  the  8th 
of  April,  I  divided  a  stricture  which  was  seated  just  behind 
the  meatus,  and  ordered  thirty  grains  of  bromide  of  potas- 
sium to  be  taken  at  intervals  of  eight  hours,  along  with 
one-sixtieth  of  a  grain  of  atropia  at  bedtime,  and  a  laxative 
pill  as  it  might  be  required. 

On  the  6th  of  May,  a  No.  30  conical  steel  bougie  having 
been  passed  at  stated  intervals  to  overcome  the  morbid 
sensitiveness  of  the  prostatic  urethra,  the  patient  reported 
that  he  had  emissions  on  the  nights  of  April  17  and  18  ; 
and  four  weeks  later  he  informed  me  that  he  had  a  pollu- 


PROGNOSIS.  151 

tion   on   the    2 2d  of  May.      Equally   rapid  and   gratifying 
results  were  obtained  in  the  following  example  : 

Case  XXXVIII.  A  teacher,  twenty-four  years  of  age,  had 
masturbated  up  to  five  years  ago.  He  then  began  to  be  troubled 
with  nocturnal  emissions,  which  frequently  occurred  for  five  con- 
secutive nights,  when  there  would  be  an  interval  of  freedom  for 
ten  days.  For  the  past  two  years  the  erections  have  been  flabby, 
and  ejaculation  has  been  premature;  but  with  the  exception  of  pain 
in  the  back,  there  have  been  no  other  signs  of  spinal  exhaustion. 
The  urethra  has  been  very  sensitive,  but  there  has  been  no  stric- 
ture. The  measures  employed  were  the  same  as  those  resorted  to 
in  the  preceding  case,  with  the  addition  of  a  hot  sitz-bath  at  night. 
He  was  ordered  to  be  awakened  early  in  the  morning,  with  the 
view  to  empty  his  bladder.  The  lumbar  pain  ceased  after  the 
fourth  insertion  of  the  bougie ;  and  when  I  saw  him,  three  weeks 
subsequently,  he  told  me  that  he  had  been  entirely  free  from  pollu- 
tions. 

Of  the  local  lesions  causative  of  nocturnal  pollutions,  by 
far  the  most  rebellious  to  treatment  which  I  have  encoun- 
tered is  chronic  inflammation  of  the  seminal  vesicles,  of 
which  the  followinor  is  an  instance  : 

o 

Case  XXXIX,  A  man,  twenty-two  years  of  age,  contracted 
gonorrhoea,  which  extended  to  the  vesicles,  where  it  set  up  acute 
inflammation.  When  he  came  to  me,  the  acute  signs  had  subsided, 
and  for  three  months  he  had  had  painful  pollutions,  which  fre- 
quently occurred  two  or  three  times  during  the  night,  when  they 
left  a  yellowish-red  stain  upon  his  linen.  There  was  a  constant 
sense  of  fulness  and  bearing-down  pain  in  the  rectum.  The  suffer- 
ing was  increased  by  urination,  defecation,  and  erections.  The 
rectal  touch  disclosed  two  ovoidal,  hot,  and  very  tender  bodies 
in  the  region  of  the  vesicles  ;  and  there  was  a  discharge  of  muco- 
purulent fluid  from  the  urethra.  Under  sedative  measures,  and  the 
local  application  of  astringent  solutions  to  the   prostatic  urethra. 


152  SPERM  ATORRHCEA. 

and  of  flying  blisters  to  the  perineum,  I  succeeded,  after  the  ex- 
piration of  seven  months,  in  reducing  the  number  of  pollutions  to 
one  a  week;  and  when  I  last  saw  him,  three  months  afterwards, 
he  had  not  had  an  emission  for  thirty  days. 

With  the  above  exception,  when  the  pollutions  are  main- 
tained by  local  lesions,  and  are  associated  with  signs  of 
myelasthenia,  the  prognosis  is  good,  but  the  patient  will 
have  to  remain  longer  under  treatment  than  when  signs  of 
nervous  exhaustion  are  absent.  The  outlook  is  still  favor- 
able when  symptoms  of  cerebrasthenia  are  present ;  but  it 
is  decidedly  bad  if  the  subject  is  a  sexual  hypochondriac. 
Even  when  the  emissions  occur  during  the  progress  of  acute 
or  chronic  general  affections,  the  prognosis  is  not  dismal, 
since  I  find  that,  in  a  case  of  progressive  muscular  atrophy 
and  commencing  bulbar  paralysis,  Stephanides  succeeded  in 
checking  them  by  the  internal  exhibition  of  atropia,  and 
that  Nowatschek  was  equally  successful  with  the  same 
remedy  in  an  example  of  an  aggravated  form  of  sperma- 
torrhoea, the  result  of  typhus. 

The  prognosis  is  far  better  when  the  usual  local  lesion, 
namely,  hypersesthesia  of  the  prostatic  urethra,  has  been 
induced  by  gonorrhoea  than  when  induced  by  masturbation  ; 
and  it  is  also  more  favorable  when  the  emissions  occur  in 
mature  years  from  sexual  excesses  than  when  they  are  due 
early  in  life  to  onanism,  especially  if  the  youthful  subjects 
evince  a  tendency  to  inherited  nervous  disorders. 

The  outlook  is  favorable  when  the  pollutions  occur  during 
the  day,  or  when  the  patient  is  awake,  and  when  they  are 
excited  by  slight  mechanical  or  psychical  causes,  as  is  illus- 
trated by  the  following  case  ; 

Case  XL.  A  merchant,  thirty-eight  years  of  age,  consulted 
me  on  the   i6th  of  October,    1883,  on  account  of  diurnal  pollu- 


TREATMENT.  153 

tions,  of  eighteen  years'  standing,  induced  by  riding,  by  impure 
thoughts,  and  even  by  bathing,  and  complicated  by  nocturnal 
emissions.  The  urethra  was  hyperaesthetic,  particularly  in  its 
prostatic  portion,  the  meatus  was  contracted,  and  a  stricture  was 
detected  immediately  behind  it.  The  stricture  and  meatus  were 
divided ;  conical  steel  bougies  of  gradually  increasing  sizes  were 
methodically  passed,  and  bromide  of  potassium,  was  administered 
for  five  weeks,  when  it  was  followed  by  the  fluid  extract  of  ergot 
for  three  weeks.  The  pollutions  finally  ceased,  and  the  man  mar- 
ried three  months  after  he  first  came  under  observation. 

Treatment. — In  all  cases  of  involuntary  seminal  emis- 
sions certain  hygienic  and  moral  rules  must  be  observed. 
The  diet  should  be  nutritious  and  digestible,  the  evening 
meal  in  particular  being  light  and  dry,  and  all  stimulating 
articles  of  food,  as  well  as  spirituous  and  malt  liquors, 
should  be  avoided.  Before  retiring,  the  bladder  is  to  be 
thoroughly  emptied,  and  the  habit  of  sleeping  on  the  side 
upon  a  hair  mattress  without  much  covering  should  be 
cultivated.  As  the  morning  fulness  of  the  bladder  has  a 
very  decided  tendency  to  induce  erections,  and  as  emissions 
usually  occur  in  the  morning,  the  patient  should  set  an 
alarm  clock  one  hour  before  the  time  at  which  he  has  usu- 
ally observed  that  the  pollutions  take  place,  in  order  that 
he  may  be  awakened  to  relieve  that  viscus  of  its  contents. 
Horseback  exercise  and  drivinof  over  rouo^h  roads  should 
be  interdicted.  Masturbation,  in  which  if  the  man  be  single 
he  still  in  all  probability  indulges,  and  sexual  intercourse 
must  be  abandoned,  and  the  patient  should  be  told  that  this 
enforced  rest  of  the  organs  will  possibly  result  in  temporary 
increased  frequency  of  the  pollutions.  Everything  calcu- 
lated to  excite  erotic  thoughts  and  desire  should  be  scrupu- 
lously avoided.  With  this  end  in  view,  he  should  keep  the 
mind  and  body  pleasantly  occupied  ;  and  if  he  happens   to 


154  SPERMATORRHCEA. 

belong  to  the  class  of  society  that  has  nothing  to  do,  and  if 
he  is  still  robust  and  vio-orous,  he  should  have  recourse  to 
gymnastic  exercises,  or  to  the  close  study  of  any  subject 
which  he  may  most  fancy.  If,  on  the  other  hand,  there  are 
commencing  or  marked  signs  of  spinal  exhaustion,  mental 
and  physical  moderation  should  be  enjoined. 

An  essential  part  of  the  treatment  is  the  removal  of  any 
reflex  or  eccentric  lesions  or  causes  which  predispose  to  the 
occurrence  of  seminal  losses,  or  even  excite  them  in  im- 
pressible subjects.  Hence,  the  external  genitalia  and  the 
anus  and  the  rectum  should  be  subjected  to  a  careful  ex- 
amination. In  many  cases  without  the  presence  of  a  posi- 
tive phimosis  the  redundant  prepuce  keeps  the  sensitive 
gland  of  the  penis  constantly  moist,  and  favors  the  collec- 
tion of  sebaceous  matter.  The  latter  condition  is  very 
common  amongf  the  lower  classes,  and  whether  circumcision 
be  resorted  to  or  not,  and  I  always  advise  it,  the  greatest 
cleanliness  should  be  enjoined.  Herpes  of  the  prepuce  and 
gland  usually  readily  yields  to  attention  to  the  bowels  and 
diet,  and  to  dusting  the  parts  with  subnitrate  of  bismuth 
and  calomel,  or  to  touching  the  excoriations,  if  they  should 
exist,  with  a  five-grain  solution  of  nitrate  of  silver,  and 
dressing  them  afterwards  with  scraped  lint.  If  the  meatus 
be  contracted,  or  if  a  stricture  be  seated  behind  that  orifice, 
it  should  be  divided  ;  and  a  short  frenum  should  be  clipped 
with  the  scissors.  Internal  oiles  should  be  li^ated  ;  external 
piles  be  opened  ;  rectal  fissure  be  divided  or  lacerated  by 
overstretching  the  sphincter  ;  and  pruritus  be  remedied  by 
cleanliness  and  the  application  of  four  grains  of  the  bichlo- 
ride of  mercury  to  the  ounce  of  water,  or  three  grains  of 
the  C3^anide  of  potassium  to  the  ounce  of  balsam  of  Peru. 
A  varicocele,  between  which  and  spermatorrhoea,  however, 
I  see  no  causal  relation,  should  be  properly  suspended,  or 


TREATMENT.  155 

be  subjected  to  subcutaneous  ligation  if  it  be  large  and 
annoying.  Habitual  constipation,  which  is  met  with  in  one- 
third  of  the  cases,  demands  particular  attention.  If  there 
is  atony  of  the  intestines,  the  compound  aloin  pill,  for  which 
the  formula  is  given  on  page  51,  will  answer  a  good  pur- 
pose. In  the  majority  of  cases  enemata  of  temperate  water 
will  fulfil  the  indication  ;  or  the  patient  may  take  two  or 
three  drachms  of  equal  parts  of  Rochelle  and  Epsom  salt 
in  a  tumbler  of  water  before  breakfast,  or  four  ounces  of 
Hunyadi  or  Friedrichshall  water,  or  of  an  artificial  mineral 
water  composed  of  an  ounce  of  sulphate  of  magnesium,  a 
drachm  of  bitartrate  of  potassium,  and  ten  grains  of  sul- 
phate of  iron  to  a  quart  of  water.  This  was  a  favorite 
remedy  of  the  late  Professor  Dunglison,  and  I  can  bear 
testimony  to  its  efficacy. 

Of  the  exciting  causes  of  abnormal  seminal  losses  by  far 
the  most  constant  and  important  are  subacute  or  chronic 
inflammation  and  hyperaesthesia  of  the  prostatic  portion  of 
the  urethra  and  of  the  orifices  of  the  ejaculatory  ducts,  con- 
ditions which  are  frequently  maintained  and  aggravated  by 
stricture  of  the  passage  anterior  to  them.  Of  the  treat- 
ment of  stricture  I  can  only  refer  to  my  views  published 
elsewhere,'  as  its  consideration  would  be  out  of  place  here; 
but  I  may  add  that,  although  the  stricture  may  be  palliated 
by  dilatation,  and  although  the  emissions  may  entirely 
cease  under  the  employment  of  that  measure,  the}'  will  be 
sure  to  recur  unless  the  bougie  is  methodically  employed 
duringr  the  remainder  of  life. 

With  regard  to  the  inflammation  and  exaggerated  sensi- 
bility and  irritability  of  the  prostatic  urethra,  I  need  only 
say  that  the  general  and  local  measures  for  their  relief  do 

^  Consult  p.  43. 


156  SPERM  ATORRHCEA. 

not  differ  in  any  respect  from  those  indicated  in  the  chapter 
on  Impotence,  pages  41-52. 

In  all  cases  of  seminal  incontinence,  with  rare  exceptions, 
the  remedies  at  the  outset  should  be  directed  to  over- 
coming the  sensibility  of  the  mucous  membrane  of  the 
urethra,  of  the  ejaculatory  ducts,  and  of  the  seminal  vesi- 
cles ;  to  subduing  the  irritability  of  the  muscles  concerned 
in  ejaculation  ;  and  to  diminishing  the  reflex  excitability  of 
the  genitospinal  centre.  Hence,  they  should  be  of  a  calm- 
ing and  sedative  nature.  By  the  ignorant  and  indiscrim- 
inate employment  of  strychnia,  cantharides,  phosphorus, 
damiana,  and  cold  sitz-baths  or  affusions  during  the  stage 
of  hyperaesthesia,  much  harm  is  done,  and  the  therapeutics 
of  spermatorrhoea  are  brought  into  disrepute.  Premising 
the  statement  that  the  tonic  should  follow  the  sedative  plan 
of  treatment,  I  will  now  give  an  oudine  of  my  views  as  to 
the  best  management  of  the  varieties  of  the  affection. 

Under  all  circumstances,  thirty  grains  of  bromide  of 
potassium,  along  with  about  ten  drops  of  the  fluid  extract 
of  gelsemium,'  every  eight  hours,  and  one-sixtieth  of  a  grain 
of  sulphate  of  atropia'  on  retiring,  are  worth  all  the  other 
internal  remedies  combined.  In  anaemic  subjects,  the  bro- 
mide may  be  administered  at  night,  and  quinine  and  iron 
be  exhibited  during  the  day  ;  but  if  the  bromide  be  badly 
borne,  it  should  be  guarded  in  the  manner  which  is  indi- 
cated on  page  50,  or  it  may  be  replaced  by  about  the  one- 
seventieth  of  a  grain  of  hydrobromate  of  hyoscine,  or  twenty 
grains  of  chloral  hydrate,  on  retiring.  Not  only  does 
atropia  diminish  the  reflex  mobility  of  the  genitospinal 
centre,  but  the   researches   of   Keuchel,   Heidenhain,  and 

1  Bartholow,  op.  cit.,  p.  415.  ^  Consult  page  50. 


TREATMENT.  157 

Strieker  and  Spina,'  show  that  it  paralyzes  the  movements 
of  the  cells  of  the  acinous  glands  and  checks  their  secre- 
tion, so  that  it  cannot  be  dispensed  with. 

Of  the  local  remedies,  the  conical  steel  bougie^  occupies 
the  first  rank  ;  but  when  the  inflammation  and  tenderness 
are  reduced  to  a  circumscribed  area  which,  includes  the 
openings  of  the  ejaculatory  ducts,  it  should  give  way  to  the 
application  of  nitrate  of  silver,^  a  remedy  which  is  usually 
decried  by  physicians  who  appear  to  have  no  practical 
experience  with  medication  of  the  urethra,  but  which  is 
highly  recommended  by  such  men  as  Trousseau,"*  Nie- 
meyer,-'  C.  Handheld  Jones, ^  and  Rosenthal,^  and  by  the 
most  eminent  surgeons.  In  addition  to  these  measures, 
the  hot  sitz-bath®  is  invaluable  ;  and  Harrison^  advises 
douching  the  lower  part  of  the  spine  with  water  at  the 
temperature  of  120°  F. 

Under  this  course  of  treatment,  the  majority  of  cases  of 
nocturnal  pollutions  recover  ;  but  it  may  happen  that  the 
reflex  genital  centre  is  still  too  impressible,  in  which  case 
galvanization, '°  with  the  anode  to  the  lumbar  region  and  the 
cathode  to  the  perineum,"  will  prove  highly  serviceable. 

After  the  hyperaesthetic  symptoms  have  subsided,  if,  from 
the  occurrence  of  diurnal  pollutions  and  of  spermorrhagia, 
there  is  reason  to  suspect  dilatation  and  atony  of  the  m(  ;uths 
of  the  ejaculatory  ducts,  the  continuous  current,  with  the 
negative   reophore  in  the  rectum,  and  the  positive  on   the 

^   Rosenthal,  Wiener  Klinik,  May,  1880,  p.  iGi. 

^  Consult  page  41.  ''  Consult  page  44. 

*  Op.  cit.,  t.  ii.  p.  643. 

°  Text-Book  of  Practical  Medicine,  New  York,  1870,  vol.  ii.  p.  100. 
®  Functional  Nervous  Disorders,  p.  733. 

^  Loc.  cit.,  p.  162.  ®  Consult  page  51. 

^  Op.  cit.,  p.  62.  '"  Consult  page  54. 

"   Benedikt,  Elektrotherapie,  p.  466. 


158  SPERM  ATORRHCEA. 

perineum  or  the  lumbar  vertebrae,  affords  the  most  strik- 
ing results.  This  plan  is  recommended  by  Mobius  ;'  and 
in  one  case  I  succeeded  in  affording  relief  in  twenty  days 
by  twelve  sittings.  Should  galvanization  prove  inadequate, 
the  induced  current  may  be  passed  through  a  negative 
catheter  electrode  in  the  prostatic  urethra  to  the  anode 
placed  on  the  perineum  or  spine  ;  but  this  mode  of  appli- 
cation requires  great  caution,"  and  care  should  be  taken  to 
employ  a  feeble  power  at  the  commencement.  Hence  I 
prefer,  with  Ultzmann,^  Rosenthal,'*  and  Mobius,  to  replace 
the  urethral  by  the  rectal  reophore.  In  the  absence  of 
electrical  apparatus,  the  tonicity  of  the  muscles  of  the  ejacu- 
latory  ducts  may  be  greatly  improved  and  even  restored 
by  the  use  of  the  psychrophor,^  by  the  application  of  nitrate 
of  silver,  and  by  cold  sitz-baths,''  and  the  dashing  of  cold 
water  against  the  perineum.  In  these  cases  of  relaxation 
and  atony  of  the  ducts,  ergot,  which,  if  I  do  not  mistake, 
was  first  employed  by  Mitchell,^  of  New  York,  is  also  indi- 
cated, half  a  drachm  of  the  fluid  extract  being  administered 
in  water  after  each  meal  ;  and  strychnia  should  also  be 
given  in  gradually  increasing  doses.  Fifteen  drops  of  a 
mixture  composed  of  six  drachms  of  tincture  of  chloride  of 
iron  and  two  drachms  of  tincture  of  cantharides  will  also 
prove  serviceable.  With  the  curious  device  of  Trousseau,^ 
namely,  an  ivory  or  vulcanite  plug  inserted  into  the  rectum, 
I  have  had  no  experience,  nor  does  it  appear  to  have  met 
with  favor.  The  same  writer  refers  to  Richard's  good  re- 
sults from  forcible  dilatation  of  the  anus  ;  and  I  can  readily 
imagine  that  it  would  be  productive  of  benefit,  if  there  was 

1  Memorabilien,  Heilbronn,  1879,  24,  p.  545- 
■    '^  Consult  page  55.  ^  Wiener  med.  Presse,  1876,  p.  641. 

*  Loc.  cit.,.p.  162.  ^  Consult  page  53. 

"  Consult  page  53.  '^  Amer.  Med.  Monthly,  April,  1861,  p.  282. 

®  Op.  cit.,  t.  ii.  p.  645. 


TREATMENT.  159 

spasm  of  the  sphincter.  Of  the  operation  of  castration, 
which  some  patients  demand,  and  which  some  surgeons  are 
weak  enough  to  perform,  I  have  only  to  say  that  I  deem  it 
unscientific  and  barbarous. 

When  spermatorrhcea  is  incident  to  organic  lesions  of  the 
cerebrospinal  axis,  or  to  convalescence  from  debilitating 
diseases,  the  treatment  is  that  of  the  affection  itself,  with 
the  addition  of  atropia  and  of  bromide  of  potassium,  if  the 
latter  remedy  is  not  contraindicated. 

To  sum  up  the  results  of  my  experience  in  the  manage- 
ment of  abnormal  seminal  losses,  I  may  add  that  the  steel 
bougie,  bromide  of  potassium,  and  atropia  are  especially 
adapted  to  cases  of  nocturnal  emissions,  and  that  electricity, 
ergot,  and  strychnia  are  the  most  reliable  agents  in  diurnal 
pollutions  and  spermorrhagia. 

After  recovery,  moderation  in  sexual  intercourse  should 
be  enjoined  if  the  patient  is  married  ;  matrimony  should  be 
advised  if  his  circumstances  and  inclinations  warrant  it ; 
and  continence  in  thought  and  in  action  should  be  observed 
if  he  remains  single.  Under  no  consideration  should  mar- 
riage be  thought  of  until  the  urethral  lesions  have  been 
subdued,  and  the  pollutions  materially  diminished  in  fre- 
quency. I  have  met  with  many  cases  in  which,  acting  upon 
the  advice  of  their  physicians,  patients  have  regretted  such 
an  action,  and  their  lives  been  rendered  miserable  from  the 
fact  that  not  only  did  the  emissions  not  cease,  but  the 
sexual  excitement  to  which  they  were  subjected  aggravated 
the  weakness  of  the  genitospinal  centre,  through  which 
one  of  the  varieties  of  impotence  was  superadded  to  the 
original  trouble. 


CHAPTER     IV. 


PROSTATORRHCEA. 


Prostatorrhcea,  an  affection  which  was  first  described 
by  S.  D.  Gross/  signifies  a  discharge  from  the  urethra  of 
the  secretion  of  the  prostate  gland,  especially  after  defeca- 
tion and  micturition.  It  may  exist  with  or  without  inflam- 
mation of  the  prostate,  representing  in  the  former  event  a 
catarrh,  and  in  the  latter  merely  a  hypersecretion  of  the 
tubular  glands  of  that  organ,  I  believe  that  the  malady  is 
generally  due  to  passive  congestion  ;  and  I  am  certain  that 
it  does  not  follow  an  attack  of  acute  inflammation  of  the 
prostate. 

In  the  majority  of  examples  prostatorrhcea  is  a  complica- 
tion of  other  disorders  of  the  generative  organs.  Thus,  of 
seventy-nine  cases  of  which  I  have  notes,  in  only  twenty- 
one  did  it  exist  alone  ;  while  it  was  associated  with  nocturnal 
pollutions  in  five,  of  which  Case  XXXIII.,  p.  134,  is  an 
illustration  ;  with  emissions  and  various  grades  of  impo- 
tence in  thirty-one,  of  which  Case  XVI.,  p.  39,  is  an  instance  ; 
with  impotence  alone  in  twenty  ;  and  with  aspermatism  in 
two,  as  in  Case  XXX.,  p.  121,  Hence  my  account  is 
limited  to  the  disease  in  its  pure  form. 

Etiology. — Of  the  twenty-one  cases,  two  began  at  the 
age  of  eighteen,  thirteen  between  twenty  and  thirty,  five 
between  thirty  and  forty  years,  and  one  at  forty-six  ;  while 

^  North  American  Med.-Chir.  Rev.,  July,  i860,  p.  693. 


ETIOLOGY.  161 

eighteen  of  the  subjects  were  single,  and  three  were  mar- 
ried. In  thirteen  it  was  due  to  masturbation,  in  five  to 
the  extension  of  gonorrhoea!  inflammation,  in  one  to  mas- 
turbation and  gonorrhoea,  and  in  two  to  onanism  practised 
early  in  life  and  to  marital  sexual  excesses.  In  all  there 
was  exaggerated  sensibility  of  the  prostatic  portion  of  the 
urethra,  which  was  complicated  by  spasm  of  the  compressor 
urethrae  muscles  in  two,  and  by  stricture  in  nineteen.  In 
eight  there  was  one  coarctation,  which  was  seated  within 
the  first  half  an  inch  of  the  canal  in  six,  and  in  the  bulb  in 
two  ;  in  ten  two  strictures  were  detected,  of  which  the  first 
was  near  the  meatus,  and  the  second  was  in  the  bulbous 
urethra  in  nine,  and  at  the  penoscrotal  junction  in  one  ; 
and  in  one  there  were  three  strictures,  which  were  seated, 
respectively,  just  behind  the  meatus,  at  two  inches  and  a 
half  from  the  meatus,  and  in  the  bulbous  urethra. 

These  observations  correspond  with  those  of  S.  D.  Gross, 
who  also  states  that  the  affection  may  be  traced  to  disorders 
of  the  rectum,  and  that  intemperance  in  eating  and  drink- 
ing, horseback  exercise,  drastic  cathartics,  cantharides,  and 
spirits  of  turpentine,  or,  in  short,  whatever  is  likely  to  pro- 
duce a  determination  of  blood  to  the  pelvic  organs,  tends 
to  excite  it.  Ledwich'  narrates  a  case  in  which  it  appears 
to  have  been  occasioned  by  riding  for  several  consecutive 
days  in  cold,  damp  weather  ;  and  both  he  and  Lee^  believe 
that  the  strumous  diathesis  predisposes  to  its  occurrence  ; 
and  others  trace  it  to  sedentary,  habits.  While  I  cannot 
deny  the  accuracy  of  these  statements,  I  may  be  permitted 
to  express  my  conviction  that  none  of  the  above-mentioned 
causes  are  capable  of  lighting  up  the  affection  indepen- 
dently of  some  preexisting  lesion  of  the  prostatic  urethra. 

^  Dublin  Quart.  Journ.  of  Med.  Sci.,  vol.  x.xiv.  p.  35. 
'■^  St.  George's  Hosp.  Reps.,  vol.  vi.  p.  26. 

11 


162 


PROSTATORRHGEA, 


Clinical  History. — The  most  prominent  symptom  of 
the  disease  is  the  discharge  of  a  thin,  and,  as  a  rule,  more 
or  less  milky,  acid  fluid  from  the  meatus,  which  may  be  con- 
stant in  its  appearance,  but  which  is  always  expressed  from 
the  urethra  during  straining  at  stool  and  during  the  forcible 
expulsion  of  the  last  drops  of  urine,  or  even  during  sneez- 
ing, coughing,  or  laughing.     The  quantity  secreted  may  be 

Fig.  i6. 


Prostatic  crystals. 

merely  sufficient  to  induce  an  unpleasant  sensation  of  wet- 
ness in  the  urethra  and  to  agglutinate  the  lips  of  its  orifice ; 
or  it  may  amount  to  a  drachm  or  more  during  the  twenty- 
four  hours,  and  keep  the  linen  stained.  However  this  may 
be,  it  is  increased  by  riding,  by  driving,  by  alcoholic  and  malt 
liquors,  and  by  the  contraction  of  the  perineal  and  other 
muscles  during  defecation  and  urination.  Under  the  micro- 
scope it  will  be  found  to  consist  of  cylindrical  epithelial 
cells,  countless  refracting  and  colorless  granules  of  lecithin, 
and  of  minute,  yellowish,  concentric,  amyloid  concretions  ; 
and  after  it  has  slowly  dried  upon  the  slide  crystals  of  phos- 
phate of  magnesium,  as  in  Fig.  1 3,  page  80,  or  of  ammonio- 


CLINICAL    HISTORY.  163 

magnesian  phosphate,  as  in  Fig.  i6  from  one  of  my  patients, 
will  make  their  appearance.  These  characters,  along  with 
the  absence  of  spermatozoa,  serve  to  distinguish  it  from 
semen  and  ordinary  urethral  discharges.  When  the  secre- 
tion depends  upon  chronic  catarrhal  inflammation  of  the 
glands  of  the  prostate,  it  is  thicker,  and  contains,  in  addi- 
tion to  the  foregoing  morphological  elements,  pus  and 
mucous  corpuscles,  and  filiform  mucopurulent  casts  of  the 
follicles  and  ducts. 

The  escape  of  the  fluid  is  occasionally  attended  with  a 
pleasurable  feeling  of  titillation  ;  or  there  may  be  a  drop- 
ping sensation  in  the  urethra,  which  is  due  to  reflex  con- 
traction of  the  muscular  substance  of  the  prostate  induced 
by  repletion  of  the  glands  with  the  secretion,  and  its  con- 
sequent discharge  into  the  prostatic  sinus;  or  there  may  be 
a  constant  feelingf  of  moisture  in  the  canal.  All  of  these 
abnormal  sensations  are  increased  by  erections. 

The  only  remaining  local  signs  with  which  I  have  met 
were  frequent  and  urgent  desire  to  relieve  the  bladder  in 
four  ;  occasional  scalding  during  urination  in  two  ;  the  loss 
of  a  few  drops  of  blood  at  the  end  of  the  act  in  two ;  painful 
ejaculation  in  one  ;  a  sense  of  weight  and  fulness  in  the 
rectum  after  stool  in  two  ;  and  dull  pains  in  the  perineum, 
which  were  increased  by  exercise,  especially  in  warm 
weather,  in  three.  Hence,  with  the  exception  of  pains 
radiating  from  the  pelvis  through  the  hips  and  thighs,  and 
a  constant  sense  of  uneasiness  about  the  loins,  these  symp- 
toms agree  with  those  portrayed  by  Adams,'  who  described 
the  affection  as  "Prostatitis  from  Onanism,"  and  they  are 
confirmatory  of  the  observations  of  S.  D.  Gross. 

Prostatorrhoea  differs  widely  from   the  affections  which 

^  Anatomy  and  Diseases  of  the  Prostate  Gland,  1851,  p.  48. 


164  PKOSTATORRHCEA. 

have  already  been  considered  in  the  absence  of  signs  which 
point  to  nervous  exhaustion,  as  I  have  met  with  them  in 
only  one  example,  of  which  the  following  is  a  brief  account : 

Case  XLI.  A  banker,  thirty-two  years  of  age,  had  masturbated 
from  his  twelfth  to  his  twenty-second  year,  when  he  married,  and, 
to  avoid  having  children,  indulged  in  incomplete  connection.  At 
the  expiration  of  six  or  eight  months  he  began  to  be  troubled  with 
intermittent  prostatic  discharges  at  stool,  and  to  experience  fatigue 
on  mental  and  physical  exertion.  When  I  saw  him,  ten  years  after 
the  appearance  of  these. symptoms,  he  was  suffering  from  habitual 
constipation,  indigestion,  acid  eructations,  furred  tongue,  bad  taste 
in  the  mouth,  dizziness,  muses  volitantes,  troubled  and  unrefresh- 
ing  sleep,  impairment  of  memory,  almost  constant  pain  in  the  back 
of  the  head,  neck,  and  left  shoulder,  incapacity  for  mental  exertion, 
muscular  weakness  of  the  limbs,  constant  pain  in  the  back,  a  sen- 
sation of  numbness  along  the  outer  side  of  the  left  thigh,  and  occa- 
sional flushes  of  heat.  The  prostatic  discharge  had  been  habitual 
for  many  years  at  the  water-closet  and  during  erections,  and  there 
was  a  sense  of  fulness  and  weight  in  the  rectum.  The  prostatic 
urethra  was  morbidly  sensitive,  and  the  bulbous  explorer  defined 
strictures  at  one-third  of  an  inch  from  the  meatus,  calibre  22,  and 
at  five  inches  and  three-quarters,  calibre  i8. 

Cases  of  a  somewhat  similar  nature  are  narrated  by 
Ledwich  ;  but  in  these  as  well  as  in  my  own  it  should  be 
remarked  that  the  signs  of  nervous  exhaustion  were  de- 
pendent upon  natural  and  unnatural  excesses,  and  were  in 
no  wise  connected  with  the  diseased  condition  of  the  pros- 
tate. In  only  two  of  the  patients  under  my  care  were  the 
bowels  habitually  costive  ;  and  in  only  one  was  there  back- 
ache. 

Sixteen  of  the  subjects  consulted  me  under  the  fixed 
impression  that  they  were  suffering  from  spermatic  incon- 
tinence, so  that  their  minds   dwelt  constantly  on  the  dis- 


PATHOLOGICAL  CHARACTERS.  165 

charge,  and  two  were  verging  upan  hypochondrism.  I 
was,  however,  fortunate  enough  to  convince  them  that  the 
fluid  was  free  from  spermatozoa,  and  in  this  way  succeeded 
in  eliminating  an  element  which  would  otherwise  have  per- 
petuated and  aggravated  the  disease. 

Pathological  Characters. — In  two  patients,  dead  of 
phthisis,  Ledwich  succeeded  in  obtaining  port-mortem  ex- 
aminations, and  describes  the  appearances  in  the  following 
terms  :  "The  prostato-vesical  plexus  was  full,  and  many  of 
its  branches  varicose  ;  the  capsule  of  the  prostate  adhered 
intimately  to  its  surface,  and,  on  slicing  the  gland,  it  seemed 
soft,  with  large,  open  venous  branches  on  the  section,  from 
which  blood  exuded,  whilst  the  whole  o-land  exhibited  an 
augmented  volume  ;  the  mucous  membrane  of  its  urethral 
aspect  was  red,  soft,  thickened,  and  villous,  whilst  the  ducts 
could  be  distinguished  with  the  unassisted  eye,  the  uvula 
and  trigone  vesicae  were  red  and  turgid,  but  the  remainder 
of  the  bladder  was  healthy." 

These  cases,  and  they  are  the  only  ones  on  record  of 
which  I  have  any  knowledge,  demonstrate  that  the  affection, 
in  some  instances,  is  essentially  a  chronic  inflammation  of 
the  glandular  apparatus  of  the  prostate,  with  relaxation, 
and  consequent  dilatation  of,  the  muscular  fibres  which 
surround  the  orifices  of  the  ducts.  Hence  the  discharge 
may  be  readily  accounted  for  by  the  contraction  of  the 
muscular  elements  incited  into  action  whenever  the  acini 
and  ducts  become  distended  by  the  abnorma  secretion,  or 
by  the  pressure  exerted  upon  them  during  the  first  expulsive 
efforts  of  defecation  and  urination.  This  view  is  moreover 
confirmed  by  the  subjective  and  objective  symptoms,  of 
which  the  most  characteristic  is  the  morbid  sensibility 
evoked  by  the  introduction  of  a  sound.      In  a  few  cases  the 


166  PROSTATORRHCEA. 

urgent  and  frequent  calls  to  empty  the  bladder,  the  scald- 
ing during  the  act,  and  the  passage  of  drops  of  blood  at  its 
completion,  point  in  the  same  direction,  as  does  also  the 
tumid  and  tender  condition  of  the  prostate,  as  elicited  by 
rectal  examination,  with  which  I  have  met  in  two  instances. 

Diagnosis. — In  the  inflammatory  form  of  the  affection,  if 
the  patient  be  requested  to  pass  the  first  two  or  three 
ounces  of  urine  in  a  Mass,  that  fluid  will  be  found  to  con- 
tain  delicate  filiform  shreds,  which  are  sometimes  more  than 
half  an  inch  in  length,  and  which  are  mucopurulent  casts  of 
the  follicles  and  ducts  of  the  prostate.  This  highly  charac- 
teristic sio-n,  when  considered  in  connection  with  the  local 
siens  and  the  minute  examination  of  the  discharo-e,  the 
composition  of  which  has  already  been  sufficiently  con- 
sidered, is  quite  sufficient  to  establish  the  true  nature  of 
the  trouble.  In  the  simple  variety  of  the  disorder,  the 
thread-like  casts  are  absent,  so  that  the  diagnosis  will  have 
to  be  based  on  the  microscopical  appearances  of  the  secre- 
tion. 

Prognosis. — Prostatorrhoea  is  a  most  obstinate  affection, 
unless  it  is  subjected  to  early  and  persevering  treatment. 
Ordinarily  the  outlook,  especially  when  the  discharge  is 
comparatively  recent,  is  most  favorable,  as  the  disease  does 
not  evince  any  tendency  to  suppuration  or  other  lesions  of 
the  body  of  the  organ.  This  statement  is  substantiated  by 
Case  XVI.,  page  39,  in  which  a  discharge  of  two  years' 
duration  entirely  ceased  under  appropriate  measures  in 
eight  weeks.  When  mental  disquietude  and  gloom  are  so 
great  that  the  patient  cannot  be  convinced  that  his  malady 
is  harmless,  the  prognosis  is  grave,  and  the  management  is 
most  unsatisfactory. 


TREATMENT.  167 

Treatment. — When  any  lesion,  as,  for  example,  stricture, 
phimosis,  or  internal  piles,  which  tends  to  maintain  the  dis- 
order has  been  relieved,  the  therapeutics  of  prostatorrhoea 
are  essentially  those  of  impotence  and  spermatorrhoea,  the 
remedies  being  addressed  to  the  relief  of  the  morbid  sensi- 
bility of  the  prostatic  sinuses,  the  atony  of  the  ducts,  and 
the  cessation  of  the  discharge.  To  avoid  needless  repeti- 
tion I  will,  therefore,  merely  indicate  the  measures  which  I 
have  found  to  yield  the  best  results. 

The  bowels  should  be  kept  in  a  soluble  condition,  and 
straining  at  the  closet  should  be  avoided.  Driving,  riding, 
and  much  walking,  if  prolonged  exercise  excites  pain  in 
the  perineum,  or  aggravates  it  if  it  be  present,  alcoholic 
and  malt  liquors,  and  sexual  intercourse  and  unnatural 
practices  must  he  interdicted.  If,  however,  the  subject  be 
married,  and  if  he  finds  that  coition  is  not  attended  with 
painful  ejaculations,  or  that  it  does  not  increase  the  sensa- 
tion of  soreness  in  the  perineum,  it  may  be  moderately 
indulged  in.  In  every  instance,  except  two  in  which  the 
affection  was  respectively  of  six  and  ten  years'  duration, 
the  warm  hip-bath,'  the  introduction  of  the  bougie,' and  the 
exhibition  of  bromide  of  potassium^  and  atropia,'^  combined 
with  tincture  of  hyoscyamus  and  bicarbonate  of  potassium 
If  there  were  vesical  irritability  and  scalding  on  urination, 
fulfilled  the  Indications.  Rosenthal, ^  Indeed,  speaks  more 
favorably  of  atropla  in  prostatic  than  In  seminal  discharges, 
and  my  own  experience  fully  confirms  his  views.  In  the 
two  exceptional  cases,  after  the  exaggerated  sensibility  of 
the  prostatic  urethra  had  been  allayed  by  the  preceding 
treatment,  and  the  discharge  was  apparently  kept  up  by  an 

'  Consult  p.  51.  ^  Consult  p.  41. 

^  Consult  p.  49.  *  Consult  p.  50. 

^  Wiener  Klinik,  May,  1880,  p_.  160. 


168  PROSTATORRHGEA. 

atonic  and  dilated  state  of  the  orifices  of  the  ducts,  I  stopped 
the  above-mentioned  measures,  but  continued  the  atropia, 
and  finally  succeeded  in  effecting  a  cure  by  the  administra- 
tion of  the  fiuid  extract  of  ergot,'  cold  sitz-baths^  morning 
and  evening,  the  injection  of  thirty  grains  of  nitrate  of 
silver  to  the  ounce, ^  and  the  application  of  fiying  blisters 
to  the  perineum,''  which  I  consider  indispensable,  Winter- 
nitz  recommends  the  psychrophor'  for  this  condition,  and 
Lederer^  also  regards  it  with  favor ;  while  Lee^  relies  upon 
the  injection  of  a  solution  composed  of  from  two  to  four 
drachms  of  the  liquor  ferri  persulphatis  to  eight  ounces  of 
water  ;  and  Ultzmann^  has  obtained  good  results  from  the 
induced  current  with  one  reophore  in  the  rectum.  I  have 
had  no  experience  with  these  remedies,  but  think  well  of 
the  last,  and  would  employ  it  if  the  case  resisted  the  mea- 
sures which  I  have  indicated. 

^  Consult  p.  158.  ^  Consult  p.  53. 

^  Consult  p.  44.  *  Consult  p.  49. 

°  Consult  p.  53. 

^  V/iener  med.  Presse,  1879,  P-'  3°^-  ^  Loc.  cit.,  p.  34. 

^  Wiener  Klinik,  May  and  June,  1879,  P-  164. 


I  N  D  E  X. 


ACETATE  of  lead  in  the  treatment 
of  azoospermism,  109 
Ansesthetic  aspermatism,  121 
diagnosis  of,  124 
prognosis  of,  126 
treatment  of,  127 
Anorchidism,  84 

Anus,  affections  of,  as  causes  of  sper- 
matorrhoea, 147 
Aspermatism,  109 
anaesthetic,  121 
atonic,  119 
organic,  no 
psychical,  123 
Atonic  aspermatism,  119 
diagnosis  of,  124 
prognosis  of,  126 
treatment  of,  126 
impotence,  20 

classification  of,  28 
clinical  history  of,  39 
diagnosis  of,  37 
etiology  of,  21 
prognosis  of,  39 
treatment  of,  41 
Atropia  in  treatment  of  impotence,  50 
of  prostatorrhoea,  167 
of  spermatorrhoea,  156 
Azoospermism,  84 
diagnosis  of,  103 
from  abnormal  states  of  semen, 

90 
from  affections  of  testes,  87 
from  anorchidism,  84 
from  cryptorchidism,  86 
from  defects  of  epididymes,  85 
from  defects  of  vasa  deferentia,  85 
from  neurasthenia,  92 


Azoospermism — 

from  obliteration    of  epididvmes, 
88 
I  from   obliteration   of  vasa    defer- 

entia, 88 
1  from  sexual  excesses,  90 

I  prognosis  of,  105 

'  treatment  of,  107 


BICHLORIDE  of  mercury  in  treat- 
ment of  azoospermism,  109 
Bromide  of  potassium  in  treatment  of 
impotence,  49 
of  prostatorrhoea,  167 
of  spermatorrhoea,  156 


CANTHARIDES  in  the  treatment  of 
spermatorrhoea,  158 
Catheter-syringe,  46 
Cerebrasthenia,  37 

Conical  bougie  in  treatment  of  impo- 
tence, 41 
of  prostatorrhoea,  167 
of  spermatorrhoea,  157 
Constipation  a  cause  of  spermatorrhcea, 

147 
Cryptorchidism,  86 
Crystals,  prostatic,  164 

spermatic,  80 
Cupped  bougie,  48 


DAMIANA  in    treatment   of    impo- 
tence, 53 
I  Diurnal  pollutions,  134 
12 


170 


INDEX. 


Ducts,  ejaculatory,  absence  of,  iil 
deviation  of,  in 
occlusion  of,  1 1 1 


ELECTRICITY  in  treatment  of  im- 
potence, 54 
of  prostatorrhoea,  i68 
of  spermatorrhoea,  157 
Epididymes,  deficiency  of,  85 

obliteration  of,  88 
Epididymitis,  gonorrhoea!,  89,  100 
Erection,  mechanism  of,  17 
Ergot  in  treatment  of   prostatorrhoea, 
168 
of  spermatorrhoea,  158 
Exhaustion,  spinal,  36 

a  cause  of  azoospermism,  92 
Exploratory  bougie,  37 


FARADISM   in  treatment  of  impo- 
tence, 55 
of  prostatorrhoea,  168 
of  spermatorrhoea,  157 


GALVANISM  in   treatment  of  azoo- 
spermism,  107 
of  impotence,  54 
of  spermatorrhoea,  157 
Gelsemium  in  treatment  of  impotence, 
50 
of  spermatorrhoea,  156 
Genitospinal  centre,  18 

diminished  excitability  of,  20 

mcreased  excitability  of,  130 

Glycerole  of  tannin    in    treatment   of 

impotence,  48 
Gonorrhoea,  a  cause  of  impotence,  28 
of  prostatorrhoea,  163 
of  spermatorrhoea,  145 
Gonorrhceal  epididymitis,  89,  100 


HERPES,  a  cause  of  spermatorrhoea, 
146 
Hyperassthesia  of  the  urethra,  a  cause  j 
of  impotence,  21 
of  prostatorrhoea,  161 
of  spermatorrhoea,  145 


IMPOTENCE,  17 
1       atonic,  20 
organic,  66 
paralytic,  34 
psychical,  57 
symptomatic,  63 
Iodide  of  potassium  in   treatment   of 

azoospermism,  109 
Iodoform  in  treatment  of  azoosperm- 
ism, 109 
Iron  in  treatment  of  impotence,  50,  52 
of  prostatorrhoea,  168 
of  spermatorrhoea,  156,  158 
Irritable  weakness,  31 
Irritation,  spinal,  36 


LAXATIVES  in  treatment  of  impo- 
tence, 51 
of  prostatorrhoea,  167 
of  spermatorrhoea,  155 


MASTURBATION,  effects  of,  22 
hypersesthesia  of  urethra  from, 
21 
nervous  disorders  from,  26 
prostatorrhoea  from,  161 
spermatorrhoea  from,  143 
stricture  of  urethra  from,  23 
Meatus,  stricture  of,  a  cause  of  sper- 
matorrhoea, 146 
Misemission,  128 
Monobromide  of  camphor  in  treatment 

of  impotence,  50 
"Morphism,  a  cause  of  azoospermism, 

97 
Myelasthenia,  36 


NEURASTHENIA,  a  cause  of  azoo- 
spermism, 92 
of  impotence,  36 
of  prostatorrhoea,  164 
of  spermatorrhoea,   142 
Nitrate  of  silver  in  treatment  of  impo- 
tence, 44 
of  prostatorrhoea,  168 
of  spermatorrhoea,  157 
Nocturnal  pollutions,  131 


IN  DEX. 


171 


ORGANIC  aspermatism,  no 
diagnosis  of,  124 
prognosis  of,  126 
treatment  of,  126 
Organic  impotence,  66 


PENIS,  lesions  of,  causes  of  impo- 
tence, 66 
Phimosis,  a  cause  of  aspermatism,  118 

of  spermatorrhoea,  146 
Phthisis,  a  cause  of  azoosperism,  95 
Pollutions,  diurnal,  134 

nocturnal,  131 
Porte-caustique,  47 
Porte-remede,  47 
Prospermatism,  32 
Prostatic  crystals,  164 
fluid,  uses  of,  79 
Prostatorrhoea,  160 

clinical  history  of,  162 
diagnosis  of,  166 
etiology  of,  160 
pathological  characters  of,  165 
prognosis  of,  Ib6 
treatment  of,  167 
Psychical  aspermatism,  123 
prognosis  of,  126 
treatment  of,  128 
impotence.  57 

treatment  of,  62 
Psychrophor    in    treatment    of    impo- 
tence, 53 
of  prostatorrhoea,  168 
of  spermatorrhoea,  158 
Purulent  semen,  98 


Q 


UININE  in  treatment  of  impotence, 

50.53 
of  spermatorrhoea,  156 


RECTUM,    affections    of,   causes    of 
prostatorrhoea,  161 
of  spermatorrhoea,  147 


SEMEN,  abnormal  conditions  of,  90- 
102 
bloody,  102 
colloid,  104 


Semen — 

composition  of,  ']'] 
purulent,  98,  104 
watery,  104 
Sexual  excesses,  causes  of  azoosperm- 
ism,  90 
of  impotence,  28 
of  prostatorrhoea,  161 
of  spermatorrhcea,  143 
Sitz-bath,  warm,  in  treatment  of  im- 
potence, 51 
of  prostatorrhoea,  167 
of  spermatorrhoea,  157 
cold,  in  treatment  of  impotence, 

53 
of  prostatorrhoea,  168 
of  spermatorrhcea,  158 
Spinal  exhaustion,  36 

a  cause  of  azoospermism,  92 
of  impotence,  36 
of  prostatorrhoea,  164 
of  spermatorrhoea,  142 
Spermaspasmos,  31 
Spermatic  crystals,  80 

colic,  124 
Spermatocystitis,  a  cause  of  azoosper- 
matism,  99 
of  spermatorrhcea,  147 
Spermatozoa,  79 
absence  of,  90 
infertile,  92-97 
Spermatorrhcea,  130 

anatomical  characters  of,  148 
classification  of,  130 
clinical  history  of,  138 
diagnosis  of,  149 
etiology  of,  141 
prognosis  of,  150 
spasmodic,  31 
treatment  of,  153 
Spermorrhagia,  136 
Sterility,  •]'] 

classification  of,  82 
from  aspermatism,  109 
from  azoospermism,  84 
from  misemission,  128 
relative  frequency  of,  83 
Stricture  of  ejaculatory  ducts,  in 

of  urethra  from  masturbation,  23 
a  cause  of  aspermatism,  116 
of  prostatorrhoea,  161 
of  spermatorrhcea,  144 
Strychnia  in  treatment  of  impotence, 
52 


172 


INDEX. 


Strychnia  in  treatment  of  spermator- 

rhcEa,  158 
Sympexions,  114 

diagnosis  of,  124 
treatment  of,  126 
Symptomatic  impotence,  63 
prognosis  of,  65 
treatment  of,  65 
Sypliilis,  a  cause  of  azoospermism,  97 


TESTES,  absence  of,  84 
atrophy  of,  87 
lesions  of,  in  azoospermism, 


Testes,  lesions  of — 

in  impotence,  74 
retained,  85 

LTRETHRA,  hypersesthesia  of,  21 
J     stricture  of,  23 
Urethral  dilator,  42 
Urethrotome,  42  ' 

VASA  deferentia,  deficiency  of,  85 
obliteration  of,  88 
Veratrum  viride  in  treatment  of  im- 
potence, 50 
Vesication  in  impotence,  49 
in  prostatorrhoea,  168 


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■annually),  and  for  The  News  (one  annually),  free  by  mail,  by  remitting  Ten  Cents  for  the 
Journal  cover,  and  Fifteen  Cents  for  the  News  cover. 


The  safest  mode  of  remittance  is  by  bank  check  or  postal  money  order,  drawn  to 
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may  be  sent  at  the  risk  of  the  publishers  by  forwarding  in  registered  letters.     Address, 

-  LEA  BEOTHEES  &  CO.,  706  and  708  Sansom  Street,  Philadelphia. 


THE  MEDICAL  NEWS  VISITING  LIST  FOB  1887. 

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-of  weights  and  measures  and  comparative  scales.  Instructions  for  examining  the  urine. 
List  of  disinfectants.  Table  of  eruptive  fevers.  Lists  of  new  remedies  and  remedies 
not  generally  used,  Incompatibles,  Poisons  and  Antidotes.  Artificial  respiration.  Table  of 
doses,  prepared  to  accord  with  the  last  revision  of  the  U.  S.  Pharmacopoeia,  an  extended 
table  of  Diseases  and  their  remedies,  and  directions  for  Ligation  of  Arteries.  Blanks 
for  all  records  of  practice  and  Erasable  tablet.  Handsomely  bound  in  limp  Morocco,  with 
tuck,  pencil,  rubber  and  catheter  scale. 

In  response  to  numerous  requests.  The  Medical  News  Visiting  List  for  1887  is 
issued  in  four  styles,  viz. :  Dated,  for  30  patients  per  week,  1  vol. ;  dated,  for  60  patients, 
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additional.    For  special  offers,  including  Visiting  List,  see  above. 


THE  MEDICAL  NEWS  PHYSICIANS'  LEDGEM, 

Containing  400  pages  of  fine  linen  "  ledger  "  paper,  ruled  so  that  all  the  accounts  of  a 
large  practice  may  be  conveniently  kept  in  it,  either  by  single  or  double  entry,  for  a  long 
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which  permits  it  to  lie  perfectly  flat  when  opened  at  any  place.  Price,  $5.00.  Also, 
a.  small  special  lot  of  same  Ledger,  with  300  pages.     Price,  $4.00. 


hahtshorne,  henry,  a,  m.,  m.  d.,  ll.  d., 

Lately  Professor  of  Hygiene  in  the  University  of  Pennsylvania, 
A  Conspectus  of  the  Medical  Sciences ;  Containing  Handbooks  on  Anatomy, 
Physiology,  Chemistry,  Materia   Medica,   Practice  of  Medicine,  Surgery  and  Obstetrics. 
Second   edition,  thoroughly  revised   and  greatly  improved.     In   one   large  royal  12mo. 
volume  of  1028  pages,  with  477  illustrations.     Cloth,  $4.25  ;  leather,  $5.00. 


The  object  of  this  manual  is  to  afford  a  conven- 
ient work  of  reference  to  students  during  the  brief 
moments  at  their  command  while  in  attendance 
upon  medical  lectures.  It  is  a  favorable  sign  that 
it  has  been  found  necessary,  in  a  short  space  of 
time,  to  issue  a  new  and  carefully  revised  edition. 
T'he  illustrations  are  very  numerous  and  unusu- 
ally clear,  and  each  part  seems  to  have  received 
its  due  share  of  attention.  We  can  conceive  such 
A  work  to  be  useful,  not  only  to  students,  but  to 
practitioners  as  well.    It  reflects  credit  upon  the 


industry  and  energy  of  its  able  editor. — Boston 
Medical  and  Surgical  Journal,  Sept.  3,  1874. 

We  can  say  with  the  strictest  truth  that  it  is  the 
best  work  of  the  kind  with  which  we  are  ac- 
quainted. It  embodies  in  a  condensed  form  all 
recent  contributions  to  practical  medicine,  and  is 
therefore  useful  to  every  busy  practitioner  through- 
out our  country,  besides  being  admirably  adapted 
to  the  use  of  students  of  medicine.  The  book  is 
faithfully  and  ably  executed. — Charleston  Medical 
Journal,  April,  1875. 


IkEILL,  JOHN,  M,  D.,   and  SMITH,  F.  G.,  M,  D,, 

Late  Surgeon  to  the  Penna.  Hospital.  Prof,  of  the  Institutes  of  Med.  in  the  TJniv.  of  Penna. 

An  Analytical  Compendium  of  the  Various  Branches  of  Medical 
Science,  for  the  use  and  examination  of  Students.  A  new  edition,  revised  and  improved. 
In  one  large  royal  12mo.  volume  of  974  pages,  with  374  woodcuts.    Cloth,  $4 ;  leather,  $4.75. 

LUDLOW,  jr.L.,M.D., 

Consulting  Physician  to  the  Philadelphia  Hospital,  etc. 

A  Manual  of  Examinations  upon  Anatomy,  Physiology,  Surgery,  Practice  of 
Medicine,  Obstetrics,  Materia  Medica,  Chemistry,  Pharmacy  and  Therapeutics.  To  which 
is  added  a  Medical  Formulary.  3d  edition,  thoroughly  revised,  and  greatly  enlarged.  In 
one  12mo.  volume  of  816  pages,  with  370  illustrations.     Cloth,  $3.25 ;  leather,  $3.75. 

The  arrangement  of  this  volume  in  the  form  of  question  and  answer  renders  it  espe- 
cially suitable  for  the  office  examination  of  students,  and  for  those  preparing  for  graduation. 


Lea  Brothers  &  Co.'s  Publications — Dictionaries. 


JDTJWGLISON,  ItOBLBY,  M.  D., 

Late  Professor  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College  of  Philadelphia. 

MEDICAL  LEXICON ;  A  Dictionary  of  Medical  Science :  (Containing 

a  concise  Explanation  of  the  various  Subjects  and  Terms  of  Anatomy,  Physiology,  Pathol- 
ogy, Hygiene,  Therapeutics,  Pharmacology,  Pharmacy,  Surgery,  Obstetrics,  Medical  Juris- 
prudence and  Dentistry,  Notices  of  Climate  and  of  Mineral  Waters,  Formulae  for  OflBcinal, 
Empirical  and  Dietetic  Preparations,  with  the  Accentuation  and  Etymology  of  the  Terms, 
and  the  French  and  other  Synonymes,  so  as  to  constitute  a  French  as  well  as  an  English 
Medical  Lexicon.  Edited  by  Kichabd  J.  Dxhstglison,  M.  D.  In  one  very  large  and 
handsome  royal  octavo  volume  oi  1139  pages.  Cloth,  $6.50 ;  leather,  raised  bands,  $7.60 ; 
very  handsome  half  Kussia,  raised  bands,  $8. 

The  object  of  the  author,  from  the  outset,  has  not  been  to  make  the  work  a  mere  lexi- 
con or  dictionary  of  terms,  but  to  afford  under  each  word  a  condensed  view  of  its  various 
medical  relations,  and  thus  to  render  the  work  an  epitome  of  the  existing  condition  of 
medical  science.  Starting  with  this  view,  the  immense  demand  which  has  existed  for  the 
work  has  enabled  him,  in  repeated  revisions,  to  augment  its  completeness  and  usefulness, 
until  at  length  it  has  attained  the  position  of  a  recognized  and  standard  authority  wherever 
the  language  is  spoken.  Special  pains  have  been  taken  in  the  preparation  of  the  present 
edition  to  .maintain  this  enviable  reputation.  The  additions  to  the  vocabulary  are  more 
numerous  than  in  any  previous  revision,  and  particular  attention  has  been  bestowed  on  the 
accentuation,  which  will  be  found  marked  on  every  word.  The  typographical  arrangement 
has  been  greatly  improved,  rendering  reference  much  more  easy,  and  every  care  has  been 
taken  with  the  mechanical  execution.  The  volume  now  contains  the  matter  of  at  least 
four  ordinary  octavos. 


About  the  first  book  purchased  by  the  medical 
student  is  the  Medical  Dictionary.  The  lexicon 
explanatory  of  technical  terms  is  simply  a  sine  qua 
non.  In  a  science  so  extensive  and  with  such  col- 
laterals as  medicine,  it  is  as  much  a  necessity  also 
to  the  practising  physician.  To  meet  the  wants  of 
students  and  most  physicians  the  dictionary  must 
be  condensed  while  comprehensive,  and  practical 
while  perspicacious.  It  was  because  Dunglison's 
met  these  indications  that  it  became  at  once  the 
dictionary  of  general  use  wherever  medicine  was 
studied  in  the  English  language.  In  no  former 
revision  have  the  alterations  and  additions  been 
so  great.  The  chief  terms  have  been  set  in  black 
letter,  while  the  derivatives  follow  in  small  caps; 
an  arrangement  which  greatly  facilitates  reference. 
— Cincinnati  Lancet  and  Clinic,  Jan.  10,  1874. 

A  book  of  which  every  American  ought  to  be 
proud.     When  the  learned  author  of  the  work 


passed  away,  probably  all  of  us  feared  lest  the  book 
should  not  maintain  its  place  in  the  advancing 
science  whose  terms  it  defines.  Fortunately,  Dr. 
Richard  J.  Dunglison,  having  assisted  his  father  in 
the  revision  of  several  editions  of  the  work,  and 
having  been,  therefore,  trained  in  the  methods 
and  imbued  with  the  spirit  of  the  book,  has  been 
able  to  edit  it  as  a  work  of  the  kind  should  be 
edited — to  carry  it  on  steadily,  without  jar  or  inter- 
ruption, along  the  grooves  of  thought  it  has  trav- 
elled during  its  lifetime.  To  show  the  magnitude 
of  the  task  which  Dr.  Dunglison  has  assumed  and 
carried  through,  it  is  only  necessary  to  state  that 
more  than  six  thousand  new  subjects  have  been 
added  in  the  present  edition. — Philadelphia  Medical 
Times,  Jan.  3, 1874. 

It  has  the  rare  merit  that  it  certainly  has  no  rival 
in  the  English  language  for  accuracy  and  extent  of 
references. — London  Medical  Gazette. 


HOBLYW,  MICMABD  jD.,  M,  D. 

A  Dictionary  of  the  Terms  Used  in  Medicine  and  the  Collateral 
Sciences.  Kevised,  with  numerous  additions,  by  Isaac  Hays,  M.  D.,  late  editor  of 
The  American  Journal  of  the  Medical  Sciences.  In  one  large  royal  12mo.  volume  of  520 
double-columned  pages.     Cloth,  $1.50 ;  leather,  $2.00. 

It  is  the  best  book  of  definitions  we  have,  and  ought  always  to  be  upon  the  student's  table. — Southern- 
Medical  and  Surgical  Journal. 

STVDBNTS'  SBMIES  OF  MAJSITALS, 

A  Series  of  Fifteen  Manuals,  for  the  use  of  Students  and  Practitioners  of  Medicine 
and  Surgery,  written  by  eminent  Teachers  or  Examiners,  and  issued  in  pocket-size 
12mo.  volumes  of  300-540  pages,  richly  illustrated  and  at  a  low  price.  The  following  vol- 
umes are  now  ready :  Treves'  Manual  of  Surgery,  by  various  writers,  in  three  volumes ; 
Bell's  Comparative  Physiology  and  Anatomy,  GtOTTLd's  Surgical  Diagnosis,  Robertson's 
Physiological  Physics,  Bruce's  Materia  Medica  and  Therapeutics,  Povs^er's  Human  Physi- 
ology, Clarke  and  Lockwood's  Dissectors'  Manual,  Ealfe's  Clinical  Chemistry,  Treves*^ 
Surgical  Applied  Anatomy,  Pepper's  Surgical  Pathology,  and  Klein's  Elements  of  Histology 
The  following  are  in  press :  Bellamy's  Operative  Surgery,  Pepper's  Forensic  Medidr^ 
and  CuRNOw's  Medical  Applied  Anatomy.      For  separate  notices  see  index  on  last  page. 

SERIES  OF  CLINICAL  MANUALS, 

In  arranging  for  this  Series  it  has  been  the  design  of  the  publishers  to  provide  the 
profession  with  a  collection  of  authoritative  monographs  on  important  clinical  subjects 
in  a  cheap  and  portable  form.  The  volumes  will  contain  about  550  pages  and  will  be 
freely  illustrated  by  chromo-lithographs  and  woodcuts.  The  following  volumes  are 
now  ready:  Marsh  on  the  Joints,  Owen  on  Surgical  Diseases  of  Children,  Morris  on 
Surgical  Diseases  of  the  Kidney,  Pick  on  Fractures  and  Dislocations,  Butlin  on  the  Tongue, 
Treves  on  Intestinal  Obstruction,  and  Savage  on  Insanity  and  Allied  Neuroses.  The 
following  will  be  ready  shortly :  Hutchinson  on  Syphilis.  The  following  are  in  active 
preparation :  Carter  &  Frost's  Ophthalmic  Surgery,  Bryant  on  the  Breast,  Broadbent 
on  the  Pulse,  Lucas  on  Diseases  of  the  Urethra,  and  Ball  on  the  Rectum  and  Anus.  For 
separate  notices  see  index  on  last  page. 


Lea  Brothers  &  Co.'s  Publications — Anatomy.  5 

GMAT,  SBWBY,  F.  B.  S., 

Lecturer  on  Anatomy  at  St.  Qeorge^s  Hospital,  London. 

Anatomy,  Descriptive  and  Surgical.  The  Drawings  by  H.  V.  Caktee,  M.  D., 
and  Dr.  Westmacott.  The  dissections  jointly  by  the  Author  and  Dr.  Carter.  With 
an  Introduction  on  General  Anatomy  and  Development  by  T.  Holmes,  M.  A.,  Surgeon  to 
St.  George's  Hospital.  Edited  by  T.  Pickering  Pick,  F.  E.  C.  S.,  Surgeon  to  and  Lecturer 
on  Anatomy  at  St.  George's  Hospital,  London,  Examiner  in  Anatomy,  Eoyal  College  of 
Surgeons  of  England.  A  new  American  from  the  tenth  enlarged  and  improved  London 
edition.  To  which  is  added  the  second  American  from  the  latest  English  edition  of 
Landmarks,  Medical  and  Sxikgical,  by  Luther  Holden,  F.  E.  C.  S.,  author  of 
"  Human  Osteology,"  "  A  Manual  of  Dissections,"  etc.  In  one  imperial  octavo  volume 
of  1023  pages,  with  564  large  and  elaborate  engravings  on  wood.  Cloth,  $6.00 ;  leather, 
$7.00 ;  very  handsome  half  Eussia,  raised  bands,  $7.50. 

This  work  covers  a  more  extended  range  of  subjects  than  is  customary  in  the  ordinary 
text-books,  giving  not  only  the  details  necessary  for  the  student,  but  also  the  application  to 
those  details  to  the  practice  of  medicine  and  surgery.  It  thus  forms  both  a  guide  for  the 
learner  and  an  admirable  work  of  reference  for  the  active  practitioner.  The  engravings 
form  a  special  feature  in  the  work,  many  of  them  being  the  size  of  nature,  nearly  all 
original,  and  having  the  names  of  the  various  parts  printed  on  the  body  of  the  cut,  in 
place  of  figures  of  reference  with  descriptions  at  the  foot.  They  thus  form  a  complete  and 
splendid  series,  which  will  greatly  assist  the  student  in  forming  a  clear  idea  of  Anatomy, 
and  will  also  serve  to  refresh  the  memory  of  those  who  may  find  in  the  exigencies  of 
practice  the  necessity  of  recalling  the  details  of  the  dissecting-room.  Combining,  as  it 
does,  a  complete  Atlas  of  Anatomy  with  a  thorough  treatise  on  systematic,  descriptive 
and  applied  Anatomy,  the  work  will  be  found  of  great  service  to  all  physicians  who  receive 
students  in  their  offices,  relieving  both  preceptor  and  pupil  of  much  labor  in  laying  the 
groundwork  of  a  thorough  medical  education. 

Landmarks,  Medical  and  Surgical,  by  the  distinguished  Anatomist,  Mr.  Luther  Holden, 
has  been  appended  to  the  present  edition  as  it  was  to  the  previous  one.  This  work  gives 
in  a  clear,  condensed  and  systematic  way  all  the  information  by  which  the  practitioner  can 
determine  from  the  external  surface  of  the  body  the  position  of  internal  parts.  Thus 
complete,  the  work,  it  is  believed,  will  furnish  all  the  assistance  that  can  be  rendered  by 
type  and  illustration  in  anatomical  study. 

There  is  probably  no  work  used  so  universally 
by  physicians  and  medical  students  as  this  one. 
It  is  deserving  of  the  confidence  that  they  repose 
in  it.  If  the  present  edition  is  compared  with  that 
issued  two  years  ago,  one  will  readily  see  how 
much  it  has  been  improved  in  that  time.  Many 
pages  have  been  added  to  the  text,  especially  in 
those  parts  that  treat  of  histology,  and  many  new 
cuts  have  been  introduced  and  old  ones  modified. 
— Journal  of  the  American  Medical  Association,  Sept. 
1, 1883. 


This  well-known  work  comes  to  us  as  the  latest 
American  from  the  tenth  English  edition.  As  its 
title  indicates,  it  has  passed  tnrough  many  hands 
and  has  received  many  additions  and  revisions. 
The  work  is  not  susceptible  of  more  improvement. 
Taking  it  all  in  all,  its  size,  manner  of  make-up, 
its  character  and  illustrations,  its  general  accur- 
acy of  description,  its  practical  aim,  and  its  per- 
spicuity of  style,  it  is  the  Anatomy  best  adapted  to 
the  wants  of  the  student  and  practitioner. — Medical 
Record,  Sept.  15, 1883. 


Also  for  sale  separate — 
HOLD  JEW,  LVTHMM,  F.  M.  O.  S., 

Surgeon  to  St.  Bartholomew's  and  the  Foundling  Hospitals,  London. 
Landmarks,  Medical  and  Surgical.     Second  American  from  the  latest  revised 
English  edition,  with  additions  by  W.  W.  Keen,  M.  D.,  Professor  of  Artistic  Anatomy  in 
the  Pennsylvania  Academy  of  the  Fine  Arts,  formerly  Lecturer  on  Anatomy  in  the  Phila- 
delphia School  of  Anatomy.     In  one  handsome  12mo.  volume  of  148  pages.     Cloth,  $1.00. 


This  little  book  is  all  that  can  be  desired  within 
its  scope,  and  its  contents  will  be  found  simply  in- 
valuable to  the  young  surgeon  or  physician,  since 
they  bring  before  him  such  data  as  he  requires  at 
every  examination  of  a  patient.  It  is  written  in 
language  so  clear  and  concise  that  one  ought 
almost  to  learn  it  by  heart.  It  teaches  diagnosis  by 
external  examination,  ocular  and  palpable,  of  the 
body,  with  such  anatomical  and  physiological  facts 
as  directly  bear  on  the  subject.  It  is  eminently 
the  student's  and  young  practitioner's  book. — Phy- 
sician and  Surgeon,  Nov.  1881. 

The  study  of  these  Landmarks  by  both  physi- 


cians and  surgeons  is  much  to  be  encouraged.  It 
inevitably  leads  to  a  progressive  education  of  both 
the  eye  and  the  touch,  by  which  the  recognition  of 
disease  or  the  localization  of  injuries  is  vastly  as- 
sisted. One  thoroughly  familiar  with  the  facts  here 
taught  is  capable  of  a  degree  of  accuracy  and  a 
confidence  of  certainty  which  is  otherwise  unat- 
tainable. We  cordially  recommend  the  Landmarks 
to  the  attention  of  every  physician  who  has  not 
yet  provided  himself  with  a  copy  of  this  useful, 
practical  guide  to  the  correct  placing  of  all  the 
anatomical  parts  and  organs. — Canada  Medical  and 
Surgical  Journal,  Dec.  1881. 


WILSOJSr,  FMASMUS,  F.  It.  S. 

A  System  of  Human  Anatomy,  General  and  Special.  Edited  by  W.  H. 
GoBRECHT,  M.  D.,  Professor  of  General  and  Surgical  Anatomy  in  the  Medical  College  of 
Ohio.  In  one  large  and  handsome  octavo  volume  of  616  pages,  with  397  illustrations. 
Cloth,  $4.00;  leather,  $5.00. 

CLFZAWD,  JOHJSr,M.iy,,F.It.S., 

Professor  of  Anatomy  and  Physiology  in  Queen's  College,  Oalway. 

A  Directory  for  tlie  Dissection  of  the  Human  Body.  In  one  12mo. 
volume  of  178  pages.    Cloth,  $1.25. 


G 


Lea  Brothers  &  Co.'s  Publications — Anatomy. 


ALLJEW,  SAMBISOJ!^,  M.  J)., 

Professor  0/  Physiology  in  the  University  of  Pennsylvania. 

A  System  of  Human  Anatomy,  Including  Its  Medical  and  Surgical 
Relations.  For  the  use  of  Practitioners  and  Students  of  Medicine.  With  an  Intro- 
ductory Section  on  Histology.  By  E.  O.  Shakespeaee,  M.  D.,  Ophthalmologist  to 
the  Philadelphia  Hospital.  Comprising  813  double-columned  quarto  pages,  with  380 
illustrations  on  109  full  page  lithographic  plates,  many  of  which  are  in  colors,  and  241 
engravings  in  the  text.  In  six  Sections,  each  in  a  portfolio.  Section  I,  Histology. 
Section  II.  Bones  and  Joints.  Section  III.  Muscles  and  Fascia.  Section  IV. 
Artekies,  Veins  and  Lymphatics.  Section  V.  Nervous  System.  Section  VI. 
Organs  of  Sense,  of  Digestion  and  Genito-Urinary  Organs,  Embryology, 
Development,  Teratology,  Superficial  Anatomy,  Post-Mortem  Examinations, 
AND  General  and  Clinical  Indexes.  Price  per  Section,  $8.50 ;  also  bound  in  one 
volume,  cloth,  $23.00 ;  very  handsome  half  Russia,  raised  baiids  and  open  back,  $25.00. 
For  sale  by  subscription  only.    Apply  to  the  Publishers. 

Extract  from  Introduction. 

It  is  the  design  of  this  book  to  present  the  facts  of  human  anatomy  in  the  manner  best 
suited  to  the  requirements  of  the  student  and  the  practitioner  of  medicine.  The  author 
believes  that  such  a  book  is  needed,  inasmuch  as  no  treatise,  as  far  as  he  knows,  contains,  in 
addition  to  the  text  descriptive  of  the  subject,  a  systematic  presentation  of  such  anatomical 
facts  as  can  be  applied  to  practice. 

A  book  which  will  be  at  once  accurate  in  statement  and  concise  in  terms ;  which  wiU  be 
an  acceptable  expression  of  the  present  state  of  the  science  of  anatomy ;  which  will  exclude 
nothing  that  can  be  made  applicable  to  the  medical  art,  and  which  will  thus  embrace  all 
of  surgical  importance,  while  omitting  nothing  of  value  to  clinical  medicine, — would  appear 
to  have  an  excuse  for  existence  in  a  country  where  most  surgeons  are  general  practitioners, 
and  where  there  are  few  general  practitioners  who  have  no  interest  in  surgery. 


It  is  to  be  considered  a  study  of  applied  anatomy 
in  its  widest  sense — a  systematic  presentation  of 
such  anatomical  facts  as  can  be  applied  to  the 
practice  of  medicine  as  well  as  of  surgery.  Our 
author  is  concise,  accurate  and  practical  in  his 
statements,  and  succeeds  admirably  in  infusing 
an  interest  into  the  study  of  what  is  generally  con- 
sidered a  dry  subject.  The  department  of  Histol- 
ogy is  treated  in  a  masterly  manner,  and  the 
ground  is  travelled  over  by  one  thoroughly  famil- 
iar with  it.    The  illustrations  are  made  with  great 


care,  and  are  simply  superb.  There  is  as  much 
of  practical  application  of  anatomical  points  to 
the  every-day  wants  of  the  medical  clinician  as 
to  those  of  the  operating  surgeon.  In  fact,  few 
general  practitioners  will  read  the  work  without  a 
feeling  of  surprised  gratification  that  so  many 
points,  concerning  which  they  may  never  have 
thought  before  are  so  well  presented  for  their  con- 
sideration. It  is  a  work  which  is  destined  to  be 
the  best  of  its  kind  in  any  language. — Medical 
Record,  Nov.  25, 1882. 


CLAItKE,W,B,,F.M.C.S.  &  LOCKWOOI>>C.B.,F,B.C.S, 

Demonstrators  of  Anatomy  at  St.  Bartholomew's  Hospital  Medical  School,  London. 
The  Dissector's  Manual.     In  one  pocket-size  12mo.  volume  of  396  pages,  with 
49  illustrations.     Limp  cloth,  red  edges,  $1.50.     See  Students^  Series  of  Manuals,  page  4. 


This  is  a  very  excellent  manual  for  the  use  of  the 
student  who  desires  to  learn  anatomy.  The  meth- 
ods of  demonstration  seem  to  us  very  satisfactory. 
There  are  many  woodcuts  which,  for  the  most 


part,  are  good  and  instructive.  The  book  is  neat 
and  convenient.  We  are  glad  to  recommend  it. — 
Boston  Medical  and  Surgical  Journal,  Jan.  17, 1884. 


THIEVES,  FBBDEMICK,  F.  M.  C,  So, 

Senior  Demonstrator  of  Anatomy  and  Assistant  Surgeon  at  the  London  Hospital. 

Surgical  Applied  Anatomy.  In  one  pocket-size  12mo.  volume  of  540  pages, 
with  61  illustrations.  Limp  cloth,  red  edges,  $2.00.  See  Students^  Series  of  Manuals, 
page  4. 


He  has  produced  a  work  which  will  command  a 
larger  circle  of  readers  than  the  class  for  which  it 
was  written.  This  union  of  a  thorough,  practical 
acquaintance  with  these  fundamental  branches. 


quickened  by  daily  use  as  a  teacher  and  practi- 
tioner, has  enabled  our  author  to  prepare  a  work 
which  it  would  be  a  most  difficult  task  to  excel. — 
The  American  Practitioner  Feb.  1884. 


Preparing. 


CJJItNOW,  JOSJSr,  M.  D.,  F,  M.  C.  F,, 

Professor  of  Anatomy  at  King's  College,  Physician  at  King's  College  Hospital. 
Medical  Applied  Anatomy.     In  one  pocket-size  12mo.  volume. 
See  Students'  Series  of  Manuals,  page  4. 

BELLA3IY,  EDWABD,  F.  M.  C.  S., 

Senior  Assistant-Surgeon  to  the  Charing- Cross  Hospital,  London. 

The  Student's  Guide  to  Surgical  Anatomy :  Being  a  Description  of  the 
most  Important  Surgical  Regions  of  the  Human  Body,  and  intended  as  an  Introduction  to 
operative  Surgery.    In  one  12mo.  volume  of  300  pages,  with  50  illustrations.    Cloth,  $2.25. 


HARTSHORNE'S  HANDBOOK  OF  ANATOMY 
AND  PHYSIOLOGY.  Second  edition,  revised. 
In  one  royal  12nio.  volume  of  310  pages,  with  220 
vroodcuts.    Cloth,  $1.75. 


HORNER'S  SPECIAL  ANATOMY  AND  HISTOL- 
OGY. Eighth  edition,  extensively  revised  and 
modified.  In  two  octavo  volumes  of  1007  pagea, 
with  320  woodcuts.    Cloth,  $6.00. 


Lea  Brothers  &  Co.'s  Publications — Pliysics,  Physiol.,  Anat.        7 
DRAPER,  JOHN  C,  M,  D.,  LL,  D., 

Professor  of  Chemistry  in  the  University  of  the  City  of  New  York. 

Medical  Physics.  A  Text-book  for  Students  and  Practitioners  of  Medicine.  In 
one  octavo  volume  of  734  pages,  with  376  woodcuts,  mostly  original.   Cloth,  $4. 

From  the  Preface. 

The  fact  that  a  knowledge  of  Physics  is  indispensable  to  a  thorough  understanding  of 
Medicine  has  not  been  as  fully  realized  in  this  country  as  in  Europe,  where  the  admirable 
works  of  Desplats  and  Gariel,  of  Robertson  and  of  numerous  German  writers  constitute  a 
branch  of  educational  literature  to  which  we  can  show  no  parallel.  A  full  appreciation 
of  this  the  author  trusts  will  be  sufficient  justification  for  placing  in  book  form  the  sub- 
stance of  his  lectures  on  this  department  of  science,  delivered  during  many  years  at  the 
University  of  the  City  of  New  York. 

Broadly  speaking,  this  work  aims  to  impart  a  knowledge  of  the  relations  existing 
between  Physics  and  Medicine  in  their  latest  state  of  development,  and  to  embody  in  the 
pursuit  of  this  object  whatever  experience  the  author  has  gained  during  a  long  period  of 
teaching  this  special  branch  of  applied  science. 


This  elegant  and  useful  work  bears  ample  testi- 
mony to  the  learning  and  good  judgment  of  the 
author.  He  has  fitted  his  work  admirably  to  the 
exigencies  of  the  situation  by  presenting  the 
reader  with  brief,  clear  and  simple  statements  of 
such  propositions  as  he  is  by  necessity  required  to 
master.  The  subject  matter  is  well  arranged, 
liberally  illustrated  and  carefully  iadexed.  That 
it  will  take  rank  at  once  among  the  text-books  is 
certain,  and  it  is  to  be  hoped  that  it  will  find  a 
place  upon  the  shelf  of  the  practical  physician, 
where,  as  a  book  of  reference,  it  will  be  found 
useful  and  agreeable. — Louisville  Medical  News, 
September  26,  1885. 

Certainly  we  have  no  text-book  as  full  as  the  ex- 
cellent one  he  has  prepared.  It  begins  with  a 
statement  of  the  properties  of  matter  and  energy. 
After  these  the  special  departments  of  physics  are 


explained,  acoustics,  optics,  heat,  electricity  and 
magnetism,  closing  with  a  section  on  electro- 
biology.  The  applications  of  all  these  to  physiology 
and  medicine  are  kept  constantly  in  view.  The 
text  is  amply  illustrated  and  the  many  difficult 
points  of  the  subject  are  brought  forward  with  re- 
markable clearness  and  ability. — Medical  and  Surg- 
ical Reporter,  July  18,  1885. 

That  this  work  will  greatly  facilitate  the  study 
of  medical  physics  is  apparent  upon  even  a  mere 
cursory  examination.  It  is  marked  by  that  scien- 
tific accuracy  which  always  characterizes  Dr. 
Draper's  writings.  Its  peculiar  value  lies  in  the 
fact  that  it  is  written  from  the  standpoint  of  the 
medical  man.  Hence  much  is  omitted  that  ap- 
pears in  a  mere  treatise  on  physical  science,  while 
much  is  inserted  of  peculiar  value  to  the  physi- 
cian.— Medical  Record,  August  22, 1885. 


MOBEBTSOJSr,  J,  McGBEGOB,  M.  A.,  M.  B,, 

Muirhead  Demonstrator  of  Physiology,  University  of  Glasgow. 
Physiological  Physics.     In  one  12mo.  volume  of  537  pages,  with  219  illustra- 
tions.    Limp  cloth,  |2.00.     See  Students'  Series  of  Manuals,  page  4. 

raents.    It  will  be  found  of  great  value  to  the 


The  title  of  this  work  sufficiently  explains  the 
nature  of  its  contents.  It  is  designed  as  a  man- 
ual for  the  student  of  medicine,  an  auxiliary  to 
his  text-book  in  physiology,  and  it  woul d  be  particu- 
larly useful  as  a  guide  to  his  laboratory  experi- 


practitioner.  It  is  a  carefully  prepared  book  of 
reference,  concise  and  accurate,  and  as  such  we 
heartily  recommend  it. — Journal  of  the  American 
Medical  Association,  Dec.  6, 1884. 


n ALTON,  jOHJsr  a,  m,  d., 

Professor  Emeritus  of  Physiology  in  the  College  of  Physicians  and  Surgeons,  New  York. 

Doctrines  of  the  Circulation  of  the  Blood.  A  History  of  Physiological 
Opinion  and  Discovery  in  regard  to  the  Circulation  of  the  Blood.  In  one  handsome 
12mo.  volume  of  293  pages.     Cloth,  $2. 

Dr.  Dalton's  work  is  the  fruit  of  the  deep  research  I  revolutionized  the  theories  of  teachers,  than  the 
of  a  cultured  mind,  and  to  the  busy  practitioner  it  discovery  of  the  circulation  of  the  blood.  This 
cannot  fail  to  be  a  source  of  instruction.  It  will  explains  the  extraordinary  interest  it  has  to  all 
inspire  him  with  a  feeling  of  gratitute  and  admir-  j  medical  historians.  The  volume  before  us  is  one 
ation  for  those  plodding  workers  of  olden  times,  i  of  three  or  four  which  have  been  written  within  a 


who  laid  the  foundation  of  the  mignificent  temple 
of  medical  science  as  it  now  stanc  s. — New  Orleans 
Medical  and  Surgical  Journal,  Aug  I  885. 

In  the  progress  of  physiologii  s,  study  no  fact 
was  of  greater  moment,  none  rr  ore  completely 


few  years  by  American  physicians.  It  is  in  several 
respects  the  most  complete.  The  volume,  though 
small  in  size,  is  one  of  the  most  creditable  con- 
tributions from  an  American  pen  to  medical  history 
that  has  appeared. — Med.  &  Surg.  Rep.,  Dec.  6, 1884. 


BELL,  F,  JEFFREY,  M.  A,, 

Professor  of  Comparative  Anatomy  at  King's  College,  London. 

Comparative  Physiology  and  Anatomy.  In  one  12mo.  volume  of  561  pages, 
with  229  illustrations.  Limp  cloth,  $2.00.     See  Students'  Series  of  Manuals,  page  4. 

The  manual  is  preeminently  a  student's  book —  1  it  the  best  work  in  existence  in  the  English 
clear  and  simple  in  language  and  arrangement.  '  language  to  place  in  the  hands  of  the  medical 
It  is  well  and  abundantly  illustrated,  and  is  read-  '  student. — Bristol  Medico- Chirurgical  Journal,  Mar., 
able  and  interesting.    On  the  whole  we  consider  |  1886. 

ELLIS,  GEORGE  VINER, 

Emeritus  Professor  of  Anatomy  in  University  College,  London. 
Demonstrations    of   Anatomy.      Being  a  Guide  to  the   Knowledge   of   the 
Human  Body  by  Dissection.     From  the  eighth  and  revised  London  edition.     In  one  very 
handsome  octavo  volume  of  716  pages,  with  249  illustrations.    Cloth,  $4.25 ;  leather,  $5.25. 

ROBERTS,  JOHN  B,,  A.  M,,  M.  D., 

Prof,  of  Applied  Anat.  and  Oper.  Surg,  in  Phila.  Polyclinic  and  Coll.  for  Ghraduates  in  Medicine. 
The  Compend  of  Anatomy.     For  use  in  the  dissecting-room  and  in  preparing 
for  examinations.     In  one  16mo.  volume  of  196  pages.     Limp  cloth,  75  cents. 


8        Lea  Brothers  &  Co.'s  Publications — Physiology,  Chemistry. 


I>AZTOW,  JOSW  C,  M.  D., 

Professor  of  Physiology  in  the  College  of  Physicians  and  Surgeons,  New  York,  etc. 

A  Treatise  on  Human  Physiology.  Designed  for  the  use  of  Students  and 
Practitioners  of  Medicine.  Seventh  edition,  thoroughly  revised  and  rewritten.  In  one 
very  handsomeoctavo  vokime  of  722  pages,  with  252  beautiful  engravings  on  wood.  Cloth, 
$5.00 ;  leather,   $6.00 ;  very  handsome  half  Russia,  raised  bands,  $6.50. 


This  edition  of  Dr.  Dalton's  well-known  work 
bears  evidence  of  having  been  thoroughly  and 
carefully  revised.  From  the  first  appearance  of 
the  book  it  has  been  a  favorite,  owing  as  well  to 
the  author's  renown  as  an  oral  teacher  as  to  the 
charm  of  simplicity  with  which,  as  a  writer,  he 
always  succeeds  in  investing  even  intricate  sub- 
jects It  must  be  gratifying  to  him  to  observe  the 
frequency  with  which  his  work,written  for  students 
and  practitioners,  is  quoted  by  other  writers  on 
physiology.  This  fact  attests  its  value,  and,  in 
great  measure,  its  originality.  It  now  needs  no 
such  seal  of  approbation,  however,  for  the  thou- 
sands who  have  studied  it  in  its  various  editions 
have  never  been  in  any  doubt  as  to  its  sterling 
worth. — N.  Y.  Medical  Journal  and  Obstetrical  Re- 
view, Oct.  1882. 

Professor  Dalton's  well-known  and  deservedly- 
appreciated  work  has  long  passed  the  stage  at 
which  it  could  be  reviewed  in  the  ordinary  sense. 
The  work  is  eminently  one  for  the  medical  prac- 
titioner, since  it  treats  most  fully  of  those  branches 


of  physiology  which  have  a  direct  bearing  on  the 
diagnosis  and  treatment  of  disease.  The  work  is 
one  which  we  can  highly  recommend  to  all  our 
readers. — Dublin  Journal  of  Medical  Science,  Feb.'83. 

Certainly  no  physiological  work  as  ever  issued 
from  the  press  that  presented  its  subject-matter  in 
a  clearer  and  more  attractive  light.  Almost  every 
page  bears  evidence  of  the  exhaustive  revision 
that  has  taken  place.  The  material  is  placed  in  a 
more  compact  form,  yet  its  delightful  charm  is  re- 
tained, and  no  subject  is  thrown  into  obscurity. 
Altogether  this  edition  is  far  in  advance  of  any 
previous  one,  and  will  tend  to  keep  the  profession 
posted  as  to  the  most  recent  additions  to  our 
physiological  knowledge. — Michigan  Medical  News, 
April,  1882. 

One  can  scarcely  open  a  college  catalogue  that 
does  not  have  mention  of  Dalton's  Physiology  as 
the  recommended  text  or  consultation-book.  For 
American  students  we  would  unreservedly  recom- 
mendDr.  Dalton's  work. —  Va. Med. Monthly,  July, ^&'i. 


FOSTER,  MICHAEL,  M,  2>.,  F,  JR,  S., 

Prelector  in  Physiology  and  Fellow  of  Trinity  College,  Cambridge,  England.  * 

Text-Book  of  Physiology.  Third  American  from  the  fourth  English  edition, 
with  notes  and  additions  by  E.  T.  Reichert,  M.  D.,  Professor  of  Physiology  in  the  Uni- 
versity of  Pennsylvania.  In  one  handsome  royal  12mo.  volume  of  908  pages,  with  271 
illustrations.    Cloth,  $3.25  ;  leather,  $3.75. 

will  be  found  to  be  much  increased. — Cincinnati 
Medical  News,  July  1885. 

For  several  years  Foster's  Physiology  has  occu- 
pied a  peculiar  and  quite  enviable  position  among 
the  textbooks  on  this  most  important  branch  of 
medicine.  In  the  highest  sense  scientific,  it 
should  nevertheless  be  the  constant  companion 
of  every  student  of  medicine.  To  the  student 
who  is  not  engaged  in  special  physiological  study 
it  should  be  the  most  constant  book  of  reference, 
while  to  him  who  is  specially  engaged  in  physio- 
logical work  it  is  an  absolute  necessity. — Journal 
of  the  American  Medical  Association,k\i.gVisi  29,1885. 


Dr.  Foster's  work  upon  physiology  is  so  well- 
known  as  a  text-book  in  this  country,  that  it  needs 
but  little  to  be  said  in  regard  to  it.  There  is 
scarcely  a  medical  college  in  the  United  States 
where  it  is  not  in  the  hands  of  the  students.  The 
author,  more  than  any  other  writer  with  whom 
we  are  acquainted,  seems  to  understand  what 
portions  of  the  science  are  essential  for  students 
to  know  and  what  may  be  passed  over  by  them  as 
not  important.  From  the  beginning  to  the  end, 
physiology  is  taught  in  a  systematic  manner.  To 
this  third  American  edition  numerous  additions, 
corrections  and  alterations  have  been  made,  so 
that  in  its  present  form  the  usefulness  of  the  book 


POWEM,  HENItT,  M,  B,,  F.  M,  C,  S., 

Examiner  in  Physiology,  Royal  College  of  Surgeons  of  England. 
Human  Physiology.      In  one  handsome  pocket-size  12mo.  volume  of  396 
with  47  illustrations.     Cloth,  $1.50.     See  Students'  Series  of  Manuals,  page  3. 

The  prominent  character  of  this  work  is  that  of  I  to  every  one  of  our  readers. —  The  American  Jowr- 
judicious  condensation,  in  which  an  able  and  sue-  |  nal  of  the  Medical  Sciences,  October,  1884. 


cessful  effort  appears  to  have  been  made  by  its 
accomplished  author  to  teach  the  greatest  number 
of  facts  in  the  fewest  possible  words.  The  result 
is  a  specimen  of  concentrated  intellectual  pabu- 
lum seldom  surpassed,  which  ought  to  be  care- 
fully ingested  and  digested  by  every  practitioner 
who  desires  to  keep  himself  well  informed  upon 
this  most  progressive  of  the  medical  sciences. 
The  volume  is  one  which  we  cordially  recommend 


This  little  work  is  deserving  of  the  highest 
praise,  and  we  can  hardly  conceive  how  the  main 
facts  of  this  science  could  have  been  more  clearly 
or  concisely  stated.  The  price  of  the  work  is  such 
as  to  placeit  within  the  reach  of  all,  while  the  ex- 
cellence of  its  text  will  certainly  secure  for  it  most 
favorable  commendation  — Cincinnati  Lancet  and 
Clinic,  Feb.  16, 1884. 


SIMON,  W,,  Ph.  n.,  M.  D., 

Professor  of  Chemistry  and  Toxicology  in  the  College  of  Physicians  and  Surgeons,  Baltimore,  and 
Professor  of  Chemistry  in  the  Maryland  College  of  Pharmacy. 
Manual  of  Chemistry.   A  Guide  to  Lectures  and  Laboratory  work  for  Beginners 
in  Chemistry.     A  Text-book,  specially  adapted  for  Students  of  Pharmacy  and  Medicine, 
In   one   8vo.  vol.  of  410  pp.,  with  16  woodcuts  and  7  plates,  mostly  of  actual  deposits, 
with  colors  illustrating  56  of  the  most  important  chemical  reactions.     Cloth,  $3.00 ;  also 
without  plates,   cloth,  $2.50. 
~"  ■    '      "  ■■  '  -  -■  -        ...      p]ates,  beautifully  executed,  illustrating  precipi- 

tates of  variotis  reactions,  form  a  novel  and  valu- 
able feature  of  the  book,  and  cannot  fail  to  be  ap- 
preciated by  both  student  and  teacher  as  a  help 
over  the  hard  places  of  the  science. — Maryland 
Medical  Journal,  Nov.  22,  1884. 


This  book  supplies  a  want  long  felt  by  students 
of  medicine  and  pharmacy,  and  is  a  concise  but 
thorough  treatise  on  the  subject.  The  long  expe- 
rience of  the  author  as  a  teacher  in  schools  of 
medicine  and  pharmacy  is  conspicuous  in  the 
perfect  adaptation  of  the  work  to  the  special  needs 
of  the  student  of  these  branches.     The  colored 


Wohler's  Outlines  of  Organic  Chemistry.    Edited  by  Fittig. 
by  Ira  Eemsen,  M.  D.,  Ph.  D.     In  one  12mo.  volume  of  550  pages.     Cloth,  $J 


Translated 


LEHMANN'S  MANUAL  OF  CHEMICAL  PHYS- 
IOLOGY. In  one  octavo  volume  of  327  pages, 
with  41  illustrations.    Cloth,  $2.25. 

CARPENTER'S  HUMAN  PHYSIOLOGY.  Edited 
by  Henry  Powt.e.    In  one  octavo  volume. 


CARPENTER'S  PRIZE  ESSAY  ON  THE  USE  AND 
Abuse  of  Alcoholic  Liquors  in  Health  and  Dis- 
ease. With  explanations  of  scientific  words.  Small 
12mo.    178  pages.     Cloth,  60  cents. 

GALLOWAY'S  QUALITATIVE  ANALYSIS. 


Lea  Brothers  &  Co.'s  Publications — Chemistry. 


9 


FOWNES,  GBOMGE,  Ph,  2>. 

A  Manual  of  Elementary  Chemistry;  Theoretical  and  Practical.  Em- 
bodying Watts'  Physical  Inorganic  Chemistry.  New  American  edition.  In  one  large 
royal  12mo.  volume  of  1061  pages,  with  168  illustrations  on  wood  and  a  colored  plate. 
Cloth,  $2.75 ;  leather,  $3.25. 


Fownes'  Chemistry  has  been  a  standard  text- 
book upon  chemistry  for  many  years.  Its  merits 
are  very  fully  known  by  chemists  and  physicians 
everywhere  in  this  country  and  in  England.  As 
the  science  has  advanced  by  the  making  of  new 
discoveries,  the  work  has  been  revised  so  as  to 
keep  it  abreast  of  the  times.  It  has  steadily 
maintained  its  position  as  a  text  book  with  medi- 
cal students.  In  this  work  are  treated  fully:  Heat, 
'  Light  and  Electricity,  including  Magnetism.  The 
influence  exerted  by  these  forces  in  chemical 
action  upon  health  and  disease,  etc.,  is  of  the  most 
important  kind,  and  should  be  familiar  to  every 
medical  practitioner.  We  can  commend  the 
work  as  one  of  the   very  best  text-books    upon 


chemistry  extant. — Cincinnati  Medical  News,  Oc- 
tober, 1885. 

Of  all  the  works  on  chemistry  intended  for  the 
use  of  medical  students,  Fownes'  Chemistry  is 
perhaps  the  most  widely  used.  Its  popularity  is 
based  upon  its  excellence.  This  last  edition  con- 
tains all  of  the  material  found  in  the  previous, 
and  it  is  also  enriched  by  the  addition  of  Watts' 
Physical  and  Inorganic  Chemistry.  All  of  the  mat- 
ter is  brought  to  the  present  standpoint  of  chemi- 
cal knowledge.  We  may  safely  predict  for  this 
work  a  continuance  of  the  fame  and  favor  it  enjoys 
among  medical  students. — New  Orleans  Medical 
and  Surgical  Journal,  March,  1886. 


FItANKLAND,B.,I>.  aZ.,F.B.S.,&JAPI*,F.M.,F,I.  C, 


Professor  of  Chemistry  in  the  Normal  School 
of  Science,  London. 


Assist.  Prof,  of  Chemistry  in  the  Normal 
School  of  Science,  London. 


Inorganic  Chemistry.     In  one  handsome  octavo  volume  of  677  pages  with  51 
woodcuts  and  2  plates.     Cloth,  $3.75  ;  leather,  $4.75. 

This  excellent  treatise  will  not  fail  to  take  its 
place  as  one  of  the  very  best  on  the  subject  of 
which  it  treats.  We  have  been  much  pleased 
with  the  comprehensive  and  lucid  manner  in 
which  the  difficulties  of  chemical  notation  and 
nomenclature  have  been  cleared  up  by  the  writers. 
It  shows  on  every  jjage  that  the  problem  of 
rendering  the  obscurities  of  this  science  easy 
of  comprehension  has  long  and  successfully 
engaged  the  attention  of  the  authors. — Medical 
and  Swgical  Reporter,  October  31, 1885. 


This  work  should  supersede  other  works  of  its 
class  in  the  medical  colleges.  Itis  certainly  better 
adapted  than  any  work  upon  chemistry, with  which 
we  are  acquainted,  to  impart  that  clear  and  full 
knowledge  of  the  science  which  students  of  med- 
icine should  have.  Physicians  who  feel  that  their 
chemical  knowledge  is  behind  the  times,  would 
do  well  to  devote  some  of  their  leisure  time  to  the 
study  of  this  work.  The  descriptions  and-demon- 
strations  are  made  so  plain  that  there  is  no  diffi- 
culty in  understanding  them. — Cincinnati  Medical 
News,  January,  1886. 


ATTFIELJy,  JOSJV,  I'll.  D., 

Professor  of  Practical  Chemistry  to  the  Pharmaceutical  Society  of  Chreat  Britain,  etc. 

Chemistry,  General,  Medical  and  Pharmaceutical ;  Including  the  Chem- 
istry of  the  U.  S.  Pharmacopoeia.  A  Manual  of  the  General  Principles  of  the  Science, 
and  their  Application  to  Medicine  and  Pharmacy.  A  new  American,  from  the  tenth 
English  edition,  specially  revised  by  the  Author.  In  one  handsome  royal  12mo.  volume 
of  728  pages,  with  87  illustrations.     Cloth,  $2.50 ;  leather,  $3.00. 

A  text-book  which  passes  through  ten  editions 
in  sixteen  years  must  have  good  qualities.  This 
remark  is  certainly  applicable  to  Attfleld's  Chem- 
istry, a  book  which  is  so  well  known  that  it  is 
hardly  necessary  to  do  more  than  note  the  appear- 
ance of  this  new  and  improved  edition.  It  seems, 
however,  desirable  to  point  out  that  feature  of  the 
book  which,  in  all  probability,  has  made  it  so 
popular.  There  can  be  little  doubt  that  it  is  its 
thoroughly  practical  character,  the  expression 
being  used  in  its  best  sense.  The  author  under- 
stands what  the  student  ought  to  learn,  and  is  able 


to  put  himself  in  the  student's  place  and  to  appre^- 
ciate  his  state  of  mind. — American  Chemical  Jov/r- 
nal,  April,  1884. 

It  is  a  book  on  which  too  much  praise  cannot  be 
bestowed.  As  a  text-book  for  medical  schools  it 
is  unsurpassable  in  the  present  state  of  chemical 
science,  and  having  been  prepared  with  a  special 
view  towards  medicine  and  pharmacy,  it  is  alike 
indispensable  to  all  persons  engaged  in  those  de- 
partments of  science.  It  includes  the  whole 
chemistry  of  the  last  Pharmacopoaia. — Pacific  Medi- 
cal and  Surgical  Journal,  Jan.  1884. 


BJLOXAM,  CSAMLES  L,, 

Professor  of  Chemistry  in  King's  College,  London. 
Chemistry,  Inorganic   and   Organic.     New  American  from  the  fifth  Lon- 
don  edition,   thoroughly  revised   and  much   improved.     In  one  very  handsome  octavo 
volume  of  727  pages,  with  292  illustrations.     Cloth,  $3.75  ;  leather,  $4.75. 

Comment  from  us  on  this  standard  work  is  al- 
most superfluous.  It  differs  widely  in  scope  and 
aim  from  that  of  Attfield,  and  in  its  way  is  equally 
beyond  criticism.  It  adopts  the  most  direct  meth- 
ods in  stating  the  principles,  hypotheses  and  facts 
of  the  science.  Its  language  is  so  terse  and  lucid, 
and  its  arrangement  or  matter  so  logical  in  se- 
quence that  the  student  never    has  occasion  to 


complain  that  chemistry  is  a  hard  study.  Much 
attention  is  paid  to  experimental  illustrations  of 
chemical  principles  and  phenomena,  and  the 
mode  of  conducting  these  experiments.  The  book 
maintains  the  position  it  has  always  held  as  one  of 
the  best  manuals  of  general  chemistry  in  the  Eng- 
lish language. — Detroit  Lancet,  Feb.  1884. 


F^MSEW,  IRA,  M,  n.,  Fh,  D., 

Professor  of  Chemistry  in  the  Johns  Hopkins  University,  Baltimore. 
Principles  of  Theoretical  Chemistry,  with  special  reference  to  the  Constitu- 
tion of  Chemical  Compounds.    Second  and  revised  edition.    In  one  handsome  royal  12mo. 
vt)lume  of  240  pages.     Cloth,  $1.75. 


That  in  so  few  years  a  second  edition  has  been 
called  for  indicates  that  many  chemical  teachers 
have  been  found  ready  to  endorse  its  plan  and  to 
adopt  its  methods.  In  this  edition  a  considerable 
proportion  of  the  book  has  been  rewritten,  much 


new  matter  has  been  added  and  the  whole  has  been 
brought  up  to  date.  We  earnestly  commend  this 
book  to  every  student  of  chemistry. — Amerirm 
Journal  of  Science,  March,  1884. 


10 


Lea  Brothers  &  Co.'s  Publications — Chemistry. 


CMAHLESf  T.  CBANSTOV^,  M.  !>.,  F,  C.  S.,  M,  S., 

Formerly  Asst.  Prof,  and  Denionst.  of  Chemistry  and  Chemical  Physics,  Queen's  College,  Belfast. 

The  Elements  of  Physiological  and  Pathological  Chemistry.     A 

Handbook  for  Medical  Students  and  Practitioners.  Containing  a  general  account  of 
Nutrition,  Foods  and  Digestion,  and  the  Cliemistry  of  the  Tissues,  Organs,  Secretions  and 
Excretions  of  the  Body  in  Health  and  in  Disease.  Together  with  the  methods  for  pre- 
paring or  separating  their  chief  constituents,  as  also  for  their  examination  in  detail,  and 
an  outline  syllabus  of  a  practical  course  of  instruction  for  students.  In  one  handsome  octavo 
volume  of  463  pages,  with  38  woodcuts  and  1  colored  plate.     Cloth,  $3.50. 


The  work  is  thoroughly  trustworthy,  and  in- 
formed throughout  by  a  genuine  scientific  spirit. 
The  author  deals  with  the  chemistry  of  the  diges- 
tive secretions  in  a  systematic  manner,  which 
leaves  nothing  to  be  desired,  and  in  reality  sup- 
plies a  want  in  English  literature.  The  book  ap- 
pears to  us  to  be  at  once  full  and  systematic,  and 
to  show  a  just  appreciation  of  the  relative  import- 
ance of  the  various  subjects  dealt  with.— ^ritis/j 
Medical  Journal,  November  29, 1884^ 


Dr.  Charles'  manual  admirably  fulfils  its  inten- 
tion of  giving  his  readers  on  the  one  hand  a  sum- 
mary, comprehensive  but  remarkably  compact,  of 
the  mass  of  facts  in  the  sciences  which  have  be- 
come indispensable, to  the  physician;  and,  on  the 
other  hand,  of  a  system  of  practical  directions  so 
minute  that  analj^ses  often  considered  formidable 
may  be  pursued  by  any  intelligent  person. — 
Archives  of  Medicine,  Dec.  1884. 


BLOFFMAJn^,  F,,  A.M„  Bh.D.f  &  FOWFM  F,B,,  FJi.D., 

Public  Analyst  to  the  State  of  New  York.  Prof,  of  Anal.  Chem.  in  the  Phil.  Coll.  of  Pharmacy. 

A  Manual  of  Chemical  Analysis,  as  applied  to  the  Examination  of  Medicinal 
Chemicals  and  their  Preparations.  Being  a  Guide  for  the  Determination  of  their  Identity 
and  Quality,  and  for  the  Detection  of  Impurities  and  Adulterations.  For  the  use  of 
Pharmacists,  Physicians,  Druggists  and  Manufacturing  Chemists,  and  Pharmaceutical  and 
Medical  Students.  Third  edition,  entirely  rewritten  and  much  enlarged.  In  one  very 
handsome  octavo  volume  of  621  pages,  with  179  illustrations.    Cloth,  $4.25. 

We  congratulate  the  author  on  the  appearance 
of  the  third  edition  of  this  work,  published  for  the 
first  time  in  this  country  also.  It  is  admirable  and 
the  information  it  undertakes  to  supply  is  both 
extensive  and  trustworthy.  The  selection  of  pro- 
cesses for  determining  the  purity  of  the  substan- 
ces of  which  it  treats  is  excellent  and  the  descrip- 


tion of  them  singularly  explicit.  Moreover,  it  is 
exceptionally  free  from  typographical  errors.  We 
have  no  hesitation  in  recommending  it  to  those 
who  are  engaged  either  in  the  manufacture  or  the 
testing  of  medicinal  chemicals. — London  Pharma- 
ceutical Journal  and  Transactions,  1883. 


CLOWES,  FJRANK,  D.  Sc,  Loudon, 

Senior  Scieiice- Master  at  the  High  School,  Newcastle-under-Lyme,  etc. 

An  Elementary  Treatise  on  Practical  Chemistry  and  Qualitative 
Inorganic  Analysis.  Specially  adapted  for  use  in  the  Laboratories  of  Schools  and 
Colleo-es  and  by  Beginners.  Third  American  from  the  fourth  and  revised  English  edition. 
In  one  very  handsome  royal  12mo.  volume  of  387  pages,  with  55  illustrations.  Cloth, 
$2.50. 

The  style  is  clear,  the  language  terse  and  vigor- 
ous. Beginning  with  a  list  of  apparatus  necessary 
for  chemical  work,  he  gradually  unfolds  the  sub- 
ject from  its  simpler  to  its  more  complex  divisions. 
It  is  the  most  readable  book  of  the  kind  we  have 
yet  seen,  and  is  without  doubt  a  systematic, 
intelligible  and  fully  equipped  laboratory  guide 


and  text  book. — Medical  Record,  July  18, 1885. 

We  may  simply  repeat  the  favorable  opinion 
which  we  expressed  after  the  examination  of  the 
previous  edition  of  this  work.  It  is  practical  in  its 
aims,  and  accurate  and  concise  in  its  statements. 
— American  Journal  of  Pharmacy,  August,  1885. 


BALFF,  CSABLFS  M,,  M.  jD.,  F,  M.  C  F., 

Assistant  Physician  at  the  London  Hospital. 
Clinical  Chemistry.     In  one  pocket-size  12mo.  volume  of  314  pages,  with  16 


illustrations.  Limp  cloth,  red  edges,  $1.50. 
This  is  one  of  the  most  instructive  little  works 
that  we  have  met  with  in  a  long  time.  The  author 
is  a  physician  and  physiologist,  as  well  as  a  chem- 
ist, consequently  the  book  is  unqualifiedly  prac- 
tical, telling  the  physician  just  wnat  he  ougnt  to 
know,  of  the  applications  of  chemistry  in  medi- 


See  Students'  Series  of  Manuals,  page  4. 
cine.  Dr.  Ralfe  is  thoroughly  acquainted  with  the 
latest  contributions  to  his  science,  and  it  is  quite 
refreshing  to  find  the  subject  dealt  with  so  clearly 
and  simply,  yet  in  such  evident  harmony  with  the 
modern  scientific  methods  and  spirit. — Medical 
Record,  February  2, 1884. 


CLASSEN,  ALEXAJfL>EIt, 

Professor  in  the  Royal  Polytechnic  School,  Aix-lorChapelle. 

Elementary  Quantitative  Analysis.  Translated,  with  notes  and  additions,  by 
Edgak  F.  Smith.  Ph.  D.,  Assistant  Professor  of  Chemistry  in  the  Towne  Scientific  School, 
University  of  Penna,     In  one  12mo.  volume  of  324  pages,  with  36  illust.     Cloth,  $2.00. 

and  then  advancing  to  the  analysis  of  minerals  and 
such  products  as  are  met  with  in  applied  chemis- 
try.   It  is  an  indispensable  book  for  students  in 


It  is  probably  the  best  manual  of  an  elementary 
nature  extant  insomuch  as  its  methods  are  the 
best.  It  teaches  by  examples,  commencing  with 
single   determinations,    followed  by  separations, 


chemistry. — Boston  Journal  of  Chemistry,  OctH878. 


GBEENE,  WILLIAM  S.,  M,  D., 

Demonstrator  of  Chemistry  in  the  Medical  Department  of  the  University  of  Pennsylvania. 
A  Manual  of  Medical  Chemistry.   For  the  use  of  Students.    Based  upon  Bow- 
man's Medical  Chemistry.   In  one  12mo.  volume  of  310  pages,  with  74  illus.    Cloth,  $1,75. 


It  is  a  concise  manual  of  three  hundred  pages, 
giving  an  excellent  summary  of  the  best  methods 
of  analyzing  the  liquids  and  solids  of  the  body,  both 
for  the  estimation  of  their  normal  constituents  and 


the  recognition  of  compounds  due  to  pathological 
conditions.  The  detection  of  poisons  is  treated 
with  sufficient  fulness  for  the  purpose  of  the  stu- 
dent or  practitioner. — Boston  Jl.  of  Chem.  June.'SO. 


Lea  Brothers  &  Co.'s  Publications — Pharm.,  Mat.  Med.,  Therap.  11 


BBVNTON,  T,  LAUDBB,  M.D,,  D.Sc,  F.M.S,,  F.M.C.JP., 

Lecturer  on  Materia  Medica  and  Therapeutics  at  St.  Bartholomew's  Hospital,  London,  etc. 

A  Text-book  of  Pharmacology,  Therapeutics  'and  Materia  Medica ; 

Including  the  Pharmacy,  the  Physiological  Action  and  the  Therapeutical  Uses  of  Drugs. 
In  one  handsome  octavo  volume  of  1033  pages,  with  188  illustrations.     Cloth,  |5.50 ; 


leather,  $6.50.     Just  ready. 

It  is  a  scientific  treatise  worthy  to  be  ranlsed  with 
the  highest  productions  in  physiology,  either  in 
our  own  or  any  other  language.  Everything  is 
practical,  the  dry,  hard  facts  of  physiology  being 
pressed  into  service  and  applied  to  the  treatment 
of  the  commonest  complaints.  The  information 
is  so  systematically  arranged  that  it  is  available 
for  immediate  use.  The  index  is  so  carefully 
compiled  that  a  reference  to  any  special  point  is 
at  once  obtainable.  Dr.  Brunton  is  never  satisfied 
with  vague  generalities,  but  gives  clear  and  pre- 
cise directions  for  prescribing  the  various  drugs 
and  preparations.  We  congratulate  students  on 
being  at  last  placed  in  possession  of  a  scientific 
treatise  of  enormous  practical  importance. — The 
London  Lancet,  June  27, 1885. 

Of  all  the  numerous  publications  of  this  year 


upon  the  subject  of  Pharmacology  the  compre- 
hensive work  of  Brunton  is  clearly  the  most 
important,  and  is  beyond  question  the  foremost 
English  handbook  of  Materia  Medica  and  Thera- 
peutics since  the  appearance  of  Pereira's  Elem  enta 
of  Materia  Medica  in  1842.  It  is  original  both  in 
the  arrangement  of  the  subjects  and  in  the  mode 
of' treatment,  and  develops  in  a  comprehensive 
manner  the  foundation  principles  of  the  science 
of  Pharmacology  without  leaving  the  needs  of  the 
practitioner  out  of  sight  for  an  instant.  In  fact, 
the  author  has  written  a  book  which  deserves  to 
be  known  far  beyond  the  boundaries  of  England, 
and  can  serve  as  a  model  for  the  pharmacological 
works  of  the  continent  on  account  of  its  happy 
combination  of  theory  with  practice. —  Virchow's 
Jahresbericht,  Berlin,  1886. 


BAItMISH,  BJDWAMJD, 

Late  Professor  of  the  Theory  and  Practice  of  Pharmacy  in  the  Philadelphia  College  of  Pharmacy. 
A  Treatise  on  Pharmacy :   designed  as  a  Text-book  for  the  Student,  and  as  a 
Guide  for  the  Physician  and  Pharmaceutist.    With  many  Formulae  and   Prescriptions. 
Fifth  edition,  thoroughly  revised,  by  Thomas  S.  WrEGAND,  Ph.  Gr.     In  one  handsome 
octavo  volume  of  1093  pages,  with  256  illustrations.     Cloth,  $5 ;  leather,  $6. 

No  thoroughgoing  pharmacist  will  fail  to  possess 
himself  of  so  useful  a  guide  to  practice,  and  no 
physician  who  properly  estimates  the  value  of  an 
accurate  knowledge  of  the  remedial  agents  em- 
ployed by  him  in  daily  practice,  so  far  as  their 


miscibility,  compatibility  and  mosteffeetive meth- 
ods of  combination  are  concerned,  can  afford  to 
leave  this  work  out  of  the  list  of  their  works  of 
reference.  The  country  practitioner,  who  must 
always  be  in  a  measure  his  own  pharmacist,  will 
find  it  indispensable. — Louisville  Medical  News, 
March  29, 1884. 

This  well-knovni  work  presents  itself  now  based 
upon   the   recently  revised  new   Pharmacopoeia. 


Each  page  bears  evidence  of  the  care  bestowed 
upon  it,  and  conveys  valuable  information  from 
the  rich  store  of  the  editor's  experience.  In  fact, 
all  that  relates  to  practical  pharmacy — apparatus, 
processes  and  dispensing — has  been  arranged  and 
described  with  clearness  in  its  various  aspects,  so 
as  to  afford  aid  and  advice  alike  to  the  student  and 
to  the  practical  pharmacist.  The  work  is  judi- 
ciously illustrated  with  good  woodcuts — American 
Journal  of^  Pharmacy,  January,  1884. 

There  is  nothing  to  equal  Parrish's  Pharmacy 
in  this  or  any  other  language. — London  Pharma,- 
ceutical  Journal. 


MBBMAJn^,  Dr,  i.. 

Professor  of  Physiology  in  the  University  of  Zurich. 
Experimental  Pharmacology.  A  Handbook  of  Methods  for  Determining  the 
Physiological  Actions  of  Drugs.  Translated,  with  the  Author's  permission,  and  with 
extensive  additions,  by  Egbert  Meade  Smith,  M.  D.,  Demonstrator  of  Physiology  in  the 
University  of  Pennsylvania.  In  one  handsome  12mo.  volume  of  199  pages,  with  32 
illustrations.     Cloth,  $1.50. 

MAISCS,  JOJSNM.,  JPJiar,  ^ 

Professor  of  Materia  Medica  and  Botany  in  the  Philadelphia  College  of  Pharmacy. 

A  Manual  of  Organic  Materia  Medica;  Being  a  Guide  to  Materia  Medica  of 
the  Vegetable  and  Animal  Kingdoms.  For  the  use  of  Students,  Druggists,  Pharmacists 
and  Physicians.  Second  edition.  In  one  handsome  royal  12mo.  volume  of  526  pages, 
with  242  illustrations.     Cloth,  $3.00. 


This  work  contains  the  substance, — the  practical 
"kernel  of  the  nut"  picked  out,  so  that  the  stu- 
dent has  no  superfluous  labor.  He  can  confidently 
accept  what  this  work  places  before  him,  without 
any  fear  that  the  gist  of  the  matter  is  not  in  it. 
Another  merit  is  that  the  drugs  are  placed  before 
him  in  such  a  manner  as  to  simplify  very  much 
the  study  of  them,  enabling  the  mind  to  grasp 
them  more  readily.    The  illustrations  are  most 


excellent,  being  very  true  to  nature,  and  are  alone 
worth  the  price  of  the  book  to  the  student.  To  the 
practical  physician  and  pharmacist  it  is  a  valuable 
work  for  handy  reference  and  for  keeping  fresh 
in  the  memory  the  knowledge  of  materia  medica 
and  botany  already  acquired.  We  can  and  do 
heartily  recommend  it. — Medical  and  Surgical  Re- 
porter, Feb.  14, 1885. 


BJRTTCE,  J,  MIICMELL,  M,  J>,,  F.  It,  C,  P., 

Physician  and  Lecturer  on  Materia  Medica  and  Therapeutics  at  Charing  Cross  Hospital,  London. 
Materia   Medica  and  Therapeutics.     An  Introduction  to  Kational  Treat- 
ment.   Fourth  edition.    In  one  pocket-size  12mo,  volume  of  591  pages.     Limp  cloth, 
$1.50.     See  Students'  Series  of  Manuals,  page  4. 

GRIFFITH:,  BOBFMT  EGLESFIELD,  M,  D. 

_  A  Universal  Formulary,  containing  the  Methods  of  Preparing  and  Adminis- 
tering Officinal  and  other  Medicines.  The  whole  adapted  to  Physicians  and  Pharmaceut- 
ists. Third  edition,  thoroughly  revised,  with  numerous  additions,  by  John  M.  Maisch, 
Phar.  D.,  Professor  of  Materia  Medica  and  Botany  in  the  Philadelphia  College  of  Pharmacv. 
In  one  octavo  volume  of  775  pages,  with  38  illustrations.     Cloth,  $4.50 ;  leather,  $5.50. 


12        Lea  Brothers  &  Co.'s  Publications — Mat.  Med.,  Tlierap. 


STILLE,  A.,  M,  !>.,  ZZ,  D.,  &  MAISCH,  J.  M.,  Thar,  I),, 


Prof essor  Emeritus  of  the  Theory  and  Prac- 
tice of  Medicine  and  of  Clinical  Medicine 
in  the  University  of  Pennsylvania. 


Prof,  of  Mat.  Med.  and  Botany  in  Phila. 
College  of  Pharmacy,  See' y  to  the  Ameri- 
can Pharmaceutical  Association. 


NEW    EDITION.-JUST    READY. 

The  National  Dispensatory. 

CONTAINING  THE  NATURAL  HISTORY,  CHEMISTRY,  PHARMACY,  ACTIONS  AND   USES  OF 

MEDICINES  INCLUDING  THOSE  RECOGNIZED  IN  THE  PHARMACOP(EIAS  OF  THE 

UNITED  STATES,  GREAT  BRITAIN  AND  GERMANY,  WITH  NUMEROUS 

REFERENCES   TO  THE  FRENCH  CODEX. 

Fourth    edition,   revised   to    October,   1886,   and    covering   the  new  British  Pharmacopcda. 

In  one  magnificent  imperial  octavo  volume  of  1794  pages,  with  311  elaborate 
engravings.  Price  in  cloth,  $7.25  ;  leather,  raised  bands,  $8.00;  very  handsome  half 
Eussia,  raised  bands  and  open  back ,  $9.00. 

%*  This  work  will  be  furnished  with  Patent  Beady  Reference  Thumb-letter  Index  for  $1.00 
in  addition  to  the  price  in  any  style  of  binding. 

In  this  new  edition  of  The  National  Dispensatory,  all  important  changes  in  the 
recent  British  Pharmacopoeia  have  been  incorporated  throughout  the  volume,  while  in 
the  Addenda  will  be  found,  grouped  in  a  convenient  section  of  24  pages,  all  therapeutical 
novelties  which  have  been  established  in  professional  favor  since  the  publication  of  the 
third  edition  two  years  ago.  Detailed  information  is  thus  given  of  the  following  among 
the  many  drugs  treated :  Antipyrin,  Cocaine  Hydrochlorate,  Cascara  Sagrada,  Fabiana, 
Franciscea,  various  new  Glycerins,  Gymnocladus,  Hydroquinon,  Hypnone,  lodol,  Jaca- 
randa.  Lanolin,  Menthol,  Phormium,  Sulphophenol,  Thallin  and  Urethan.  In  this 
edition,  as^  always  before,  The  National  Dispensatory  may  be  said  to  be  the  represent- 
ative of  the  most  recent  state  of  American,  English,  German  and  French  Pharmacology, 
Therapeutics  and  Materia  Medica. 


Thif,  the  most  comprehensive  of  the  several 
commentaries  on  the  Pharmacopoeias  of  the  United 
States,  Great  Britain  and  Germany  which  has  yet 
appeared,  has  by  this  last  revision  been  brought 
fully  up  to  the  existing  knovcledge  upon  the  sub- 
ject treated.  Its  references  to  the  British  Phar- 
macopceia  have  been  amended  for  the  late  and 
much-changed  new  edition  of  that  work;  an  "ad- 
denda" of  twenty-five  pages  has  been  appended, 
treating  of  the  latest  and  most  important  addi- 
tions to  the  materia  medica.  This  work  should 
be  in  the  hands  of  every  physician  and  pharma- 
cist.— Boston  Medical  and  Surgical  Journal,  Feb.  10, 
1887. 

The  previous  editions  of  The  National  Dispensa- 
tory have  from  time  to  time  been  brought  before 
our  readers,  and  that  in  1884  left  apparently  little 
to  be  desired,  as  the  authors  had  entirely  remod- 
elled their  work,  and  also  brought  its  contents  up 
to  the  latest  possible  period.  The  publication  of 
the  revised  British  Pharmacopoeia  has,  however, 
necessitated  another  edition,  embracing  the  nu- 


merous changes  therein  embodied,  and  the  oppor- 
tunity has  thus  been  afforded  of  supplying 
information  on  the  unoflScinal  additions  which 
have,  during  the  past  two  years,  been  made  to  the 
materia  medica. — Canadian  Pharmaceutical  Jour- 
nal, Feb.  1887. 

This,  the  most  comprehensive  and  exhaustive 
commentary  on  the  Pharmacopoeias  of  the  United 
States,  Great  Britain  and  Germany  which  has  yet 
appeared,  might  with  great  propriety  have  been 
called  the  International  Dispensatory.  By  this 
last  revision  it  has  been  brought  fully  up  to  the 
limit  of  existing  knowledge  upon  the  subject 
treated.  The  references  to  the  British  Pharma- 
copoeia have  been  changed  to  correspond  with  the 
latest  and  greatly  altered  edition  of  that  work. 
Besides  other  features  of  improvement,  the  most 
recent  advances  have  been  embraced  in  the  shape 
of  ''Addenda"  of  all  new  and  important  articles. 
No  pharmacist  will  be  without  this  work,  and  no 
physician  will  be  without  it. — The  American  Prac- 
titioner and  News,  February  19, 1887. 


FAMQVSABSOW,  BOBERT,  M.  !>., 

Lecturer  on  Materia  Medica  at  St.  Mary's  Hospital  Medical  School. 

A  Guide  to  Therapeutics  and  Materia  Medica.  Third  American  edition, 
specially  revised  by  the  Author.  Enlarged  and  adapted  to  the  U.  S.  Pharmacopoeia  by 
Frank  Woodbury,  M.  D.    In  one  handsome  12mo.  volume  of  524  pages.     Cloth,  $2.25. 

Dr.  Farquharson's  Therapeutics  is  constructed 
upon  a  plan  which  brings  before  the  reader  all  the 
essential  points  with  reference  to  the  properties  of 
drugs.  It  impresses  these  upon  him  in  such  a  way 
as  to  enable  him  to  take  a  clear  view  of  the  actions 
ol  medicines  and  the  disordered  conditions  in 
which  they  must  prove  useful.    The  double-col- 


umned pages — one  side  containing  the  recognized 
physiological  action  of  the  medicine,  and  the  other 
the  disease  in  which  observers  (who  are  nearly  al- 
ways mentioned)  have  obtained  from  it  good  re- 
sults— make  a  very  good  arrangement.  The  early 
chapter  containing  rules  for  prescribing  is  excel- 
lent.— Canada  Med.  and  Surg.  Journal,  Dec.  1882. 


EBES,  MOBEBT  T.,  M.  D., 

Jackson  Professor  of  Clinical  Medicine  in  Harvard  University,  Medical  Department. 

A  Text-Book  of  Materia  Medica  and  Therapeutics.  In  one  octavo  volume 
of  about  600  pages,  with  illu&trations.     Preparing. 

STIZZE,  AZFBEZ^,  M.  B.,  ZZ,  !>., 

Professor  of  Theory  and  Practice  of  Med.  and  of  Clinical  Med.  in  the  Univ.  of  Penna. 
Therapeutics  and  Materia  Medica.     A  Systematic  Treatise  on  the  Action  and 
Uses  of  Medicinal   Agents,  including  their   Description   and  History.     Fourth   edition, 
revised  and  enlarged.     In  two  large  and  handsome  octavo  volumes,  containing  1936  pages. 
Cloth,  $10.00 ;  leather,  $12.00 ;  very  handsome  half  Eussia,  raised  bands,  $13.00. 


Lea  Brothers  &  Co.'s  Publications — Pathol.,  Histol. 


13 


COATS,  JOSBJPMf  M.  JD.,  F.  F.  F,  S., 

Pathologist  to  the  Glasgow  Western  Infirmary. 
A  Treatise  on  Pathology.     In  one  very  handsome  octavo  volume  of  829  pages, 
with  339  beautiful  illustrations.     Cloth,  |5.50 ;  leather,  $6.50. 


The  work  before  us  treats  the  subject  of  Path- 
ology more  extensively  than  it  is  usually  treated 
In  similar  works.  Medical  students  as  well  as 
physicians,  who  desire  a  work  for  study  or  refer- 
ence, that  treats  the  subjects  in  the  various  de- 
partments in  a  very  thorough  manner,  but  without 
prolixity,  will  certainly  give  this  one  the  prefer- 
ence to  any  with  which  we  are  acquainted.  It  sets 
forth  the  most  recent  discoveries,  exhibits,  in  an 
interesting  manner,  the  changes  from  a  normal 
condition  eflFected  in  structures  by  disease,  and 
points  out  the  characteristics  of  various  morbid 
agencies,  so  that  they  can  be  easily  recognized.  But, 
not  limited  to  morbid  anatomy.it  explains  fully  how 
the  functions  of  organs  are  disturbed  by  abnormal 
conditions.    There  is  nothing  belonging  to  its  de- 


partment of  medicine  that  is  not  as  fully  elucidated 
as  our  present  knowledge  will  admit. — Cincinnati 
Medical  News,  Oct.  1883.     ' 

One  of  the  best  features  of  this  reatise  consists 
in  the  judicious  admixture  of  foreign  observation 
with  private  experience.  Thus  the  subject  is 
presented  in  a  harmonious  manner,  facilitating 
the  study  of  single  topics  and  making  the  entire 
volume  profitable  and  pleasant  reading.  The 
author  includes  in  his  descriptions,  general 
pathology  as  well  as  the  special  pathological  histol- 
ogy of  the  different  systems  and  organs.  He  has 
succeeded  in  offering  to  students  and  practition- 
ers a  thoroughly  acceptable  work. — Medical  Record, 
Dec.  22,  1883. 


GMFFJ^,  T,  ELENRY,  M,  I),, 

Lecturer  on  Pathology  and  Morbid  Anatomy  at  Charing-Cross  Hospital  Medical  School,  London. 

Pathology  and.  Morbid  Anatomy.  Fifth  American  from  the  sixth  revised 
and  enlarged  English  edition.  In  one  very  handsome  octavo  volume  of  482  pages,  with 
150  line  engravings.     Cloth,  $2.50. 

The  fact  that  this  well-known  treatise  has  so 
rapidly  reached  its  sixth  edition  is  a  strong  evi- 
dence of  its  popularity.  The  author  is  to  be  con- 
gratulated upon  the  thoroughness  with  which  he 
has  prepared  this  work.  It  is  thoroughly  abreast 
with  all  the  most  recent  advances  in  pathology. 
No  work  in  the  English  language  is  so  admirably 
adapted  to  the  wants  of  the  student  and  practi- 
tioner as  this,  and  we  would  recommend  it  most 
earnestly  to  every  one. — Nashville  Journal  of  Medi- 
cine and  Surgery,  Nov.  1884. 


An  extended  review  of  such  a  well-known  book 
is  unnecessary.  We  had  already  regarded  the 
book  as  a  model  of  its  kind,  and  the  author's  as- 
surance that  he  believes  the  present  edition  to  be 
fully  up  to  date  will  be  received  as  sufficient 
proof  that  nothing  of  importance  has  been  omitted. 
The  book  has  been  most  carefully  revised,  and 
bears  upon  every  page  the  marks  of  the  care  and 
accuracy  that  have  won  for  it  an  international 
reputation. — New  York  Medical  and  Surgical  Jour- 
nal, July  18,  1885. 


WOODHEAD,  G.  SIMS,  M.  J>.,  F.  R.  C,  F.  E., 

Demonstrator  of  Pathology  in  the  University  of  Edinburgh. 
Practical  Pathology.     A  Manual  for  Students  and  Practitioners.     In  one  beau- 
tifdl  octavo  volume  of  497  pages,  with  136  exquisitely  colored  illustrations.     Cloth,  $6.00. 

It  forms  a  real  guide  for  the  student  and  practi-  themselves  with  this  manual.  The  numerous 
tioner  who  is  thoroughly  In  earnest  in  his  en-  drawings  are  not  fancied  pictures,  or  merely 
deavor  to  see  for  himself  and  do  for  himself.  To  schematic  diagrams,  but  they  represent  faithfully 
the  laboratory  student  it  will  be  a  helpful  com-  the  actual  images  seen  under  the  microscope, 
panion,  and  all  those  who  may  wish  to  familiarize  The  author  merits  all  praise  for  having  produced 
themselves  with  modern  methods  of  examining  a  valuable  work. — Medical  Record,  May  31, 1884. 
morbid  tissues    are    strongly  urged    to    provide 


SCHAFER,  EI>WARD  A.,  F.  R,  S., 

Assistant  Professor  of  Physiology  in  University  College,  London, 
The  Essentials  of  Histology,      in  one  octavo  volume  of  246  'pages,  with 

281  illustrations.     Cloth,  $2.25. 

This  short  volume  might  be  called  a  companion 
book  to  Green's  Pathology,  and  fills  the  same  place 
in  histology  the  latter  occupies  in  pathology.  This 
book  is  so  short,  clear  and  satisfactory,  as  to  invite 
perusal,  and  repay  any  time  spent  in  doing  so.  We 
think  the  book  deserving  of  the  highest  praise. 
— New  Orleans  Med.  and  Surg.  Journal,  Dec.  1885. 

This  admirable  work  is  a  cheering  example  of 


well-won  success,  earned  by  the  faithful  and  dili- 
gent pursuit  of  excellence  in  presentation  of  this 
essential  foundation  of  all  true  medical  science. 
Since  this  new  work  of  Professor  Sctiafer's  will 
doubtless  be  speedily  placed  upon  the  list  of  text- 
books required  in  every  medical  college,  we  feel 
that  it  needs  no  further  recommendation  at  our 
hands. — Am.  Jour,  of  the  Med.  Sciences,  Jan.  1886. 


KLEIJSr,  E.,  M.  D.,  F,  R.  S., 

Joint  Lecturer  on  General  Anat.  and  Phys.  in  the  Med.  School  of  St.  Bartholomew'' s  Hosp.,  London. 
Elements  of  Histology.   In  one  pocket-size  12mo.  volume  of  360  pages,  with  181 
illus.    Limp  cloth,  red  edges,  $1.50.     See  Students'  Series  of  Manuals,  page  4. 

This  little  volume,  originally  intended  by  its 
able  author  as  a  manual  for  medical  students, 
contains  much  valuable  information,  systematic- 
ally arranged,  that  will  be  acceptable  to  the 
general  practitioner.  It  gives  a  graphic  and  lucid 
description  of  every  tissue  and  organ  in  the  hu- 


man body;  and,  while  small  in  size,  it  is  full  to 
overflowing  with  important  facts  in  regard  to  these 
multiform  and  complex  structures.  We  know  of 
no  book  of  its  size  that  will  prove  of  greater  va'ue 
to  medical  students  and  practitioners  of  medi- 
cine.—  The  Southern  Practitioner,  Nov.  1883. 


FEFFER,  A,  J.,  M,  B.,  M,  S.,  F,  R.  C.  S,, 

Surgeon  and  Lecturer  at  St.  Mary's  Hospital,  London. 
Surgical  Pathology.     In  one  pocket-size  12mo.  volume  of  511  pages,  with  81 
illustrations.  Limp  cloth,  red  edges,  $2.00.     See  Students'  Series  of  Manuals,  page  4. 


It  is  not  pretentious,  but  it  will  serve  exceed 
ingly  well  as  a  book  of  reference.  It  embodies  a 
great  deal  of  matter,  extending  over  the  whole 
field  of  surgical  pathology.  Its  form  is  practical, 
its  language  is  clear,  and  the  information  set 
forth    is   well-arranged,    well-indexed   and  well- 


illustrated.  The  student  will  find  in  it  nothing 
that  is  unnecessary.  The  list  of  subjects  covers 
the  whole  range  of  surgery.  The  book  supplies  a 
very  manifest  want  and  should  meet  with  suc- 
cess.— New  York  Medical  Journal,  May  31,  1884. 


Cornil  and  Ranvier's    Pathological    Histology.  —  Translated  by  E.  O. 
Shakespeaee,  M.  D.,  and  J.  Henry  C.  Simes,  M.  D.    Octavo,  800  pp.,  360  illustrations. 


14 


Lea  Brothers  &  Co.'s  Publications — ^Practice  of  Med. 


FLINT,  AVSTIJS^,  M.  J>., 

Prof,  of  the  Principles  and  Practice  of  Med.  and  of  Clin.  Med.  in  Bellevue  Hospital  Medical  College,  N.  T. 

A  Treatise  on  the  Principles  and  Practice  of  Medicine.  Designed  for 
the  use  of  Students  and  Practitioners  of  Medicine.  New  (sixth)  edition,  thoroughly  re- 
vised and  rewritten  by  the  Author,  assisted  by  William  H.  Welch,  M.  D.,  Professor  of 
Pathology,  Johns  Ho'pkins  University,  Baltimore,  and  Austin  Flint,  Je.,  M.  D.,  Professor 
of  Physiology,  Bellevue  Hospital  Medical  College,  N.  Y.  In  one  very  handsome  octavo 
volume  of  about  1170  pages,  with  illustrations.  Cloth,  |5.50;  leather,  ^6.50;  very 
handsome  half  Eussia,  raised  bands,  $7.00. 


No  text-book  on  the  principles  and  practice  of 
medicine  has  ever  met  in  this  country  with  such 
general  approval  by  medical  students  and  practi- 
tioners as  the  vpork  of  Professor  Flint.  In  all  the 
medical  colleges  of  the  United  States  it  is  the  fa- 
vorite work  upon  Practice;  and,  as  we  have  stated 
before  in  alluding  to  it,  there  is  no  other  medical 
work  that  can  be  so  generally  found  in  the  libra- 
ries of  physicians.  Jn  every  state  and  territory 
of  this.vast  country  the  book  that  will  be  most  likely 
to  be  found  in  the  ofifice  of  a  medical  man,  whether 
in  city,  town,  village,  or  at  some  cross-roads,  is 
Flint's  Practice.  We  make  this  statement  to  a 
considerable  extent  from  personal  observation,  and 
it  is  the  testimony  also  of  others.  An  examina- 
tion shows  that  very  cons-iderable  changes  have 
been  made  in  the  sixth  edition.  The  work  may  un- 
doubtedly be  regarded  as  fairly  representing  the 
present  state  of  the  science  of  medicine,  and  as 


reflecting  the  views  of  those  who  exemplify  in 
their  practice  the  present  stage  of  progress  of  med- 
ical art. — Cincinnati  Medical  Keics,  Oct.  1886. 

He  was  a  born  teacher,  a  teacher  by  the  bedside, 
a  teacher  in  the  lecture-room,  a  teacher  to  the  in- 
dividual pupil,  and  a  teacher  to  thousands  of  stu- 
dents. He  was  a  constiant  teacher  with  his  pen. 
He  lived  to  collect,  to  analyze,  and  so  to  formulate 
new  ideas,  which  were  freely  given  to  the  pro- 
fession of  his  choice.  This"  volume,  more  per- 
fectly than  any  previous  edition,  gathers  up  and 
completes  an  account  of  all  those  matters  which 
may  fairly  be  discussed  in  a  work  on  the  practice 
of  medicine.  It  is  a  work  of  which  any  American 
physician  can  well  be  proud,  when  he  compares 
it  with  the  best  that  has  been  done  in  a  similar  way 
by  any  writer  in  any  country  or  any  age. — The 
American  Lancet,  Nov.  1886. 


JBLAMTSSOBNE,  JEBNRT,  M,  !>.,  LL,  D., 

Lately  Professor  of  Hygiene  in  the  University  of  Pennsylvania. 

Essentials  of  the  Principles  and  Practice  of  Medicine.  A  Handbook 
for  Students  and  Practitioners.  Fifth  edition,  thoroughly  revised  and  rewritten.  In  one 
royal  12mo.  volume  of  669  pages,  with  144  illustrations.     Cloth,  $2.75 ;  half  bound,  $3.00. 


Within  the  compass  of  600  pages  it  treats  of  the 
history  of  medicine,  general  pathology,  general 
symptomatology, and  physical  diagnosis  (including 
laryngoscope,  ophthalmoscope,  etc.),  general  ther- 
apeutics, nosology,  and  special  pathology  and  prac- 
tice. There  is  a  wonderful  amount  of  information 
contained  in  this  work,  and  it  is  one  of  the  best 
of  its  kind  that  we  have  seen. — Glasgow  Medical 
Journal,  Nov.  1882. 

An  indispensable  book.  No  work  ever  exhibited 
a  better  average  of  actual  practical  treatment  than 


this  one;  and  probably  not  one  writer  in  our  day 
had  a  better  opportunity  than  Dr.  Hartshorne  for 
condensing  all  the  views  of  eminent  practitioners 
into  a  12mo.  The  numerous  illustrations  will  be 
very  useful  to  students  especially.  These  essen- 
tials, as  the  name  suggests,  are  not  intended  to 
supersede  the  text-books  of  Flint  and  Bartholow, 
but  they  are  the  most  valuable  in  affording  the 
means  to  see  at  a  glance  the  whole  literature  of  any 
disease,  and  the  most  valuable  treatment. — Chicago 
Medical  Journal  and  Examiner,  April,  1882. 


BRISTOWB,  JOMN  SYEM,  31.  !>.,  F.  B.  C.  F., 

Physician  and  Joint  Lecturer  on  Medicine  at  St.  Thomas^  Hospital,  London. 

A  Treatise  on  the  Practice  of  Medicine.  Second  American  edition,  revised 
by  the  Author.  Edited,  with  additions,  by  James  H.  Hutchinson,  M.D.,  physician  to  the 
Pennsylvania  Hospital.  In  one  handsome  octavo  volume  of  1085  pages,  with  illustrations. 
Cloth,  $5.00 ;  leather,  $6.00 ;  very  handsome  half  Russia,  raised  bands,  $6.50. 

The  book  is  a  model  of  conciseness,  and  com- 
bines, as  successfully  as  one  could  conceive  it  to 
be  possible,  an  encyclopaedic  character  with  the 
smallest  dimensions.  It  differs  from  other  admi- 
rable text-books  in  the  completeness  with  which 
it  covers  the  whole  field  of  medicine. — Michigan 
Med'cal  News,  May  10,  1880. 

His  accuracy  in  the  portraiture  of  disease,  his 
care  in  stating  subtle  points  of  diagnosis,  and  the 
faithfully  given  pathology  of  abnormal  processes 
have  seldom  been  surpassed.  He  embraces  many 
diseases  not  usually  considered  to  belong  to  theory 


and  practice,  as  skin  diseases,  syphilis  and  insan- 
ity, but  they  will  not  be  objected  to  by  readers,  aa 
he  has  studied  them  conscientiously,  and  drawn 
from  the  life. — Medical  and  Surgical  Reporter,  De- 
cember 20,  1879. 

The  reader  will  find  every  conceivable  subject 
connected  with  the  practice  of  medicine  ably  pre- 
sented, in  a  style  at  once  clear,  interesting  and 
concise.  The  additions  made  by  Dr.  Hutchinson 
are  appropriate  and  practical,  and  greatly  add  to 
its  usefulness  to  American  readers. — Buffalo  Med- 
ical and  Surgical  Journal,  March,  1880. 


WATSOW,  SIB  TSOMAS,  M.  D,, 

Late  Physician  in  Ordinary  to  the  Queen. 

Lectures  on  the  Principles  and  Practice  of  Physic.  A  new  American 
from  the  fifth  English  edition.  Edited,  with  additions,  and  190  illustrations,  by  Henry 
Hartshorne,  A.  M.,  M.  D.,  late  Professor  of  Hygiene  in  the  University  of  Pennsylvania. 
In  two  large  octavo  volumes  of  1840  pages.     Cloth,  $9.00  ;  leather,  $11.00. 


LECTURES  ON  THE  STUDY  OF  FEVER.  By 
A.  Hudson,  M.  D.,  M.  R.  I.  A.  In  one  octavo 
volume  of  308  pages.    Cloth,  82.50. 

STOKES'  LECTURES  ON  FEVER.  Edited  by 
John  William  Moore,  M.  D.,  F.  K.  Q.  C.  P.  In 
one  octavo  volume  of  280  pages.    Cloth,  82.00. 


A  TREATISE  ON  FEVER.  By  Robeht  D.  Lyons, 
K.  C.  C.    InoneSvo.  vol.  of354pp.    Cloth,  82.25. 

LA  ROCHE  ON  YELLOW  FEVER,  considered  in 
its  Historical,  Pathological,  Etiological  and 
Therapeutical  Relations.  In  two  large  and  hand- 
some octavo  volumes  of  1468  pp.    Cloth,  87.00. 


A  CENTURY  OV  AMERICAN  MEDICINE,  1776—1876.    By    Dra.  E.  H.  Clabkb,  H.  J. 
BiQELOw,  S.  D.  Gross,  T.  G.  Thomas,  and  J.  S.  Billings.    In  one  12mo.  volume  of  370  pages.    Cloth,  82.25. 


Lea  Brothers  &  Co.'s  Publications — System  of  Med. 


15 


For  Sale  by  Subscription  Only. 


A  System  of  Practical  Medicine. 

BY  AMERICAN  AUTHORS. 

Edited  by  WILLIAM   PEPPER,  M.  D.,  LL.  D., 

PROVOST  AND  PROFESSOR  OF  THE  THEORY  AND  PRACTICE  OF  MEDICINE  AND   OF 
CLINICAL  MEDICINE  IN  THE  UNIVERSITY  OF  PENNSYLVANTAj 

Assisted  by  Louis  Starr,  M.  D.,  Clinical  Professor  of  the  Diseases  of  Children  in  the 
Hospital  of  the  University  of  Pennsylvania. 

The  complete  work,  in  five  volumes,  containing  5573  pages,  with  198  illustrations,  is  just  ready. 
Price  per  volume,  cloth,  $5 ;  leather,  $Q ;  half  Russia,  raised  bands  and  open  back,  $7. 


In  this  great  work  American  medicine  is  for  the  first  time  reflected  by  its  worthiest 
teachers,  and  presented  in  the  full  development  of  the  practical  utility  which  is  its  pre- 
eminent characteristic.  The  most  able  men — from  the  East  and  the  West,  from  the 
North  and  the  South,  from  all  the  prominent  centres  of  education,  and  from  all  the 
hospitals  which  aiford  special  opportunities  for  study  and  practice — have  united  in 
generous  rivalry  to  bring  together  this  vast  aggregate  of  specialized  experience. 

The  distinguished  editor  has  so  apportioned  the  work  that  to  each  author  has  been 
assigned  the  subject  which  he  is  peculiarly  fitted  to  discuss,  and  in  which  his  views 
will  be  accepted  as  the  latest  expression  of  scientific  and  practical  knowledge.  The 
practitioner  will  therefore  find  these  volumes  a  complete,  authoritative  and  unfailing  work 
of  reference,  to  which  he  may  at  all  times  turn  with  full  certainty  of  finding  what  he  needs 
in  its  most  recent  aspect,  whether  he  seeks  information  on  the  general  principles  of  medi- 
cine, or  minute  guidance  in  the  treatment  of  special  disease.  So  wide  is  the  scope  of  the 
work  that,  with  the  exception  of  midwifery  and  matters  strictly  surgical,  it  embraces  the 
■whole  domain  of  medicine,  including  the  departments  for  which  the  physician  is  accustomed 
to  rely  on  special  treatises,  such  as  diseases  of  women  and  children,  of  the  genito-urinary 
organs,  of  the  skin,  of  the  nerves,  hygiene  and  sanitary  science,  and  medical  ophthalmology 
and  otology.  Moreover,  authors  have  inserted  the  formulas  which  they  have  found  most 
efficient  in  the  treatment  of  the  various  aflTections.  It  may  thus  be  truly  regarded  as  a 
Complete  Library  of  Practical  Medicine,  and  the  general  practitioner  possessing  it 
may  feel  secure  that  he  will  require  little  else  in  the  daily  round  of  professional  duties. 

In  spite  of  every  effort  to  condense  the  vast  amount  of  practical  information  fur- 
nished, it  has  been  impossible  to  present  it  in  less  than  5  large  octavo  volumes,  containing 
about  5600  beautifully  printed  pages,  and  embodying  the  matter  of  about  15  ordinary 
octavos.     Illustrations  are  introduced  wherever  requisite  to  elucidate  the  text. 

A  detailed  prospectus  of  the  work  will  be  sent  to  any  address  on  application  to  the 
pMishers. 


These  two  volumes  bring  this  admirable  work 
to  a  close,  and  fully  sustain  the  high  standard 
reached  by  the  earlier  volumes;  we  have  only 
therefore  to  echo  the  eulogium  pronounced  upon 
them.  We  would  warmly  congratulate  the  editor 
and  his  collaborators  at  the  conclusion  of  their 
laborious  task  on  the  admirable  manner  in  which, 
from  first  to  last,  they  have  performed  their  several 
duties.  They  have  succeeded  in  producing  a 
work  which  will  long  remain  a  standard  work  of 
reference,  to  which  practitioners  will    look    for 

fuidanee,  and  authors  will  resort  to  for  facts. 
'rom  a  literary  point  of  view,  the  work  is  without 
any  serious  blemish,  and  in  respect  of  production, 
it  has  the  beautiful  finish  that  Americans  always 
give  their  works. — Edinburgh  Medical  Journal,  Jan. 
1887. 

*  *  Thegreatestdistinctively  American  work  on 
the  practice  of  medicine,  and,  indeed,  the  super- 
lative adjective  would  not  be  inappropriate  were 
even  all  other  productions  placed  in  comparison. 
An  examination  of  the  five  volumes  is  sufficient 
to  convince  one  of  the  magnitude  of  the  enter- 
prise, and  of  the  success  which  has  attended  its 
fulfilment.— TAe  Medical  Age,  July  26,  1886. 

Convenience  and  good  order,  witn  easy  refer- 
ence, are  no  less  characteristic  than  the  almost 
uniform  excellence  of  the  matter. — New  York 
Medical  Journal,  June  19,  1886. 

We  consider  it  one  of  the  grandest  works  on 
Practical  Medicine  in  the  EngUsh  language.  It  is 
a  work  of  which  the  profession  of  this  country  can 
feel  proud.  Written  exclusively  by  American 
physicians  who  are  acquainted  with  all  the  varie- 
ties of  climate  in  the  United  States,  the  character 
of  the  soil,  the  manners  and  customs  of  the  peo- 


ple, etc.,  it  is  peculiarly  adapted  to  the  wants 
of  American  practitioners  of  medicine,  and  it 
seems  to  us  that  every  one  of  them  would  desire 
to  have  it.  It  has  been  truly  called  a  "Complete 
Library  of  Practical  Medicine,"  and  the  general 
practitioner  will  require  little  else  in  his  round 
of  professional  duties. — Cincinnati  Medical  News, 
March,  1886. 

Each  of  the  volumes  is  provided  with  a  most 
copious  index,  and  the  work  altogether  promises 
to  be  one  which  will  add  much  to  the  medical 
literature  of  the  present  century,  and  reflect  great 
credit  upon  the  scholarship  and  practical  acumen 
of  its  authors. —  The  London  Lancet,  Oct.  3,  1885. 

The  feeling  of  proud  satisfaction  with  which  the 
American  profession  seps  this,  its  representative 
system  of  practical  medicine  issued  to  the  medi- 
cal world,  is  fully  justified  by  the  character  of  the 
work.  The  entire  caste  of  the  system  is  in  keep- 
ing with  the  best  thoughts  of  the  leaders  and  fol- 
lowers of  our  home  school  of  medicine,  and  the 
combination  of  the  scientific  study  of  disease  and 
the  practical  application  of  exact  and  experimen- 
tal knowledge  to  the  treatment  of  human  mal- 
adies, makes  every  one  of  us  share  in  the  pride 
that  has  welcomed  Dr.  Pepper's  labors.  Sheared 
of  the  prolixity  that  wearies  the  readers  of  the 
German  school,  the  articles  glean  these  same 
fields  for  all  that  is  valuable.  It  is  the  outcome 
of  American  brains,  and  is  marked  throughout 
by  much  of  the  sturdy  independence  of  thought 
and  originality  that  is  a  national  characteristic. 
Yet  nowhere  is  there  lack  of  study  of  the  most 
advanced  views  of  the  day. — North  Carolina  Medi- 
cal Journal,  Sept.  1886, 


16  Lea  Brothers  &  Co.'s  Publications — Clinical  Med.,  etc. 

BJEYNOLnS,  J,  BVSSBLL,  M,  JD., 

Professor  of  the  Principles  and  Practice  of  Medicine  in  University  College,  London. 
A  System  of  Medicine.  Witli  notes  and  additions  by  Hexe,"X  Hartshoene, 
A.  M.,  M.  D.,  late  Professor  of  Hygiene  in  the  University  of  Pennsylvania.  In  three  large 
and  handsome  octavo  volumes,  containing  3056  double-columned  pages,  with  317  illustra- 
tions. Price  per  volume,  cloth,  $5.00 ;  sheep,  $6.00 ;  very  handsome  half  Russia,  raised  bands, 
$6.50.  Per  set,  cloth,  $15;  leather,  $18;  half  Russia,  $19.50.  Sold  only  by  subscription. 
For  conciseness  and  comprehensiveness  in  the  |  this  index  can  fully  appreciate. — Michigan  Medical 
treatment  of  all  the  subjects  embraced  under  the  '  Neivs,  June  10,  1880. 

head  of  "Practice  of  Bledicine,"  there  is  no  work  There  is  no  medical  work  which  we  have  in 
in  the  English  language,  or  in  any  other  language,  ]  times  past  more  frequently  and  fully  consulted 
for  that  matter,  which  equals,  much  less  excels,  |  when  perplexed  by  doubts  as  to  treatment,  or  by 


Reynolds'  System.  Each  volume  contains  a  com- 
plete index — a  feature  which  those  who  may  have 
encyclopaedic  works  on  medicine  not  containing 


having  unusual  or  apparently  inexplicable  symp- 
toms presented  to  us  than  Reynolds'  System  at 
Medicine. — Am.  Journ.  of  Med.  Sci.,  January,  1880. 


STILZE,  ALFItBD,  M.  D,,  LL,  D., 

Professor  Emeritus  of  the  Theory  and  Practice  of  Med.  and  of  Clinical  Med.  in  the  Univ.  of  Penna, 
Cholera :   Its  Origin,  History,  Causation,  Symptoms,  Lesions,  Prevention  and  Treat- 
ment. In  one  handsome  12mo.  volume  of  163  pages,  with  a  chart.  Cloth,  $1.25.  Just  ready. 
This  timely  little  work  is  full  of  the  learning 


and  good  judgment  which  marks  all  that  comes 
from  the  pen  of  its  distinguished  author.  What 
he  has  to  say  on  treatment  is  characterized  by 
his  usual  caution  and  his  well-known  preference 


for  a  rational  system.  Altogether,  the  monograph 
is  one  that  will  have  an  excellent  influence  on  the 
professional  mind. — Medical  and  Surgical  Reporter, 
August  1, 1885. 


FIWLAYSOJS^,  JA3IBS,  M.  !>.,  Editor, 

Physician  and  Lecturer  on  Clinical  Medicine  in  the  Olasgow  Western  Infirmary,  etc 
Clinical  Diagnosis.  A  Handbook  for  Students  and  Practitioners  of  Medicine, 
With  Chajsters  by  Prof.  Gairdner  on  the  Physiognomy  of  Disease ;  Prof.  Stephenson  on 
Diseases  of  the  Female  Organs;  Dr.  Robertson  on  Insanity;  Dr.  Gemmell  on  Physical 
Diagnosis ;  Dr.  Coats  on  Laryngoscopy  and  Post-Mortem  Examinations,  and  by  the  Editor 
on  Case-taking,  Family  History  and  Symptoms  of  Disorder  in  the  Various  Systems.  New 
edition.  In  one  handsome  12mo.  volume  of  682  pages,  with  158  illustrations.  Cloth, 
$2.50.     Just  ready. 


We  are  pleased  to  see  a  second  edition  of  this 
admirable  book,  which  occupies  a  position  in 
medical  literature  that  previous  to  the  first  ap- 
pearance of   this  work  was    unoccupied.      It  is 


tions  maintain  its  present  standard  of  excellence! 
It  is  a  book  which  will  greatly  aid  the  work  of 
the  clinical  teacher,  and  should  be  thoroughly 
digested    by  every  student  of    medicine.      The 


essentially  a  practical  treatise  on  medical  diagno-  j  general  practitioner  will  find  many  practical  hints 
sis,  in  which  every  sign  and  symptom  of  disease  I  in  its  pages,  while  a  careful  study  of  the  work 
is  carefully  analyzed,  and  their  relative  signifi-  j  will  save  him  from  many  pitfalls  in  diagnosis, 
cance  in  the  ditferent  affections  in  which  they  j  The  book,  therefore,  in  our  opinion,  commends 
occur  pointed  out.  From  their  synthesis  the  stu-  i  itself  to  a  wide  field  of  readers,  and  we  sincerely 
dent  can  accurately  determine  the  disease  with  j  wish  it  the  great  success  which  it  so  richly  merits, 
which  he  has  to  deal.  The  book  has  no  competi-  — Liverpool  Medico-Chirurgical  Journal,  Jan.  1887. 
tor,  nor  is  it  likely  to  have  as  long  as  future  edi-  | 

FOTSEMGILLf  J.  M,,  M.  D.,  Edin,,  M.  M,  C.  JP,,  Lond., 

Physician  to  the  City  of  London  Hospital  for  Diseases  of  the  Chest. 

The  Practitioner's  Handbook  of  Treatment ;  Or,  The  Principles  of  Thera- 
peutics.  New  edition.     In  one  octavo  volume  of  about  700  pages.     Cloth,  $3.75.    Shortly. 

BMOADBEWT,  W.  BC.,  M.  B.,  F,  B.  C.  B., 

Physician  to  and  Lecturer  on  Medicine  at  St.  Mary's  Hospital. 
The  Pulse.    In  one  12mo.  volume.   Preparing.    See  Series  of  Clinical  Manuals,  page  4. 


FENWICK,  SAJKUEB,  M,  D., 

Assistant  Physician  to  the  London  Hospital. 

The  Student's  Guide  to  Medical  Diagnosis.  From  the  third  revised  and 
enlarged  English  edition.  In  one  very  handsome  royal  12mo.  volume  of  328  pages,  with 
87  illustrations  on  wood.     Cloth,  $2.25. 

HABEBSSOW,  S.  O.,  31,  B., 

Senior  Physician  to  and  late  Led.  on  Principles  and  Practice  of  Med.  at  Ghiy's  Hospital,  London. 

On  the  Diseases  of  the  Abdomen ;  Comprising  those  of  the  Stomach,  and 
other  parts  of  the  Alimentary  Canal,  (Esophagus,  Caecum,  Intestines  and  Peritoneum.  Second 
American  from  third  enlarged  and  revised  English  edition.  In  one  handsome  octavo 
volume  of  554  pages,  with  illustrations.     Cloth,  $3.50. 


TAJn^EM,  THOMAS  BCAWKES,  M,  B. 

A  Manual  of  Clinical  Medicine  and  Physical  Diagnosis.  Third  American 
from  the  second  -London  edition.  Revised  and  enlarged  by  TrLBimY  Fox,  M.  D. 
In  one  small  12mo.  volume  of  362  pages,  with  illustrations.     Cloth,  $1.50. 


Lea  Brothers  &  Co.'s  Publications — Hygiene,  Electr.,  Pract.        17 


BICSARJDSON,  B.  W.,  M,A,,  M,D.,  T.L.  J>.,  F.It.S.,  F.S.A. 


Fellow  of  the  Royal  College  ol  Physicinw.,  Jonaon. 

Preventive  Medicine.     In  one  octavo  volume  ot  729  pages. 
$5;  very  handsone  halt  ±i  .ssia,  raised  bands,  %b.b^ . 


Cloth,  |4;  leather, 


Pr.  Richar'asop  ha:-  ...  .:.'<^,.;f-  >  in  producing  a 
work  which  is  elevated  in  conception,  comprehen- 
sive in  scope,  scientific  in  character,  systematic  in 
arrangement,  and  wliich  is  written  in  a  clear,  con- 
cise and  pleasant  manner.  He  evinces  the  happy 
faculty  of  extracting  the  pith  of  what  is  known  on 
the  subject,  and  of  presenting  it  in  a  most  simple, 
intelligent  and  practical  form.  There  is  perhaps 
no  similar  work  written  for  the  general  public 
thatcontains  such acomplete, reliable  and  instruc- 
tive collection  of  data  upon  the  diseases  common 
to  the  race,  their  origins,  causes,  and  the  measures 
for  their  prevention.  The  descriptions  of  diseases 
are  clear,  chaste  and  scholarly;  the  discussion  of 
the  question  of  disease  is  comprehensive,  masterly 
and  fully  abreast  with  the  latest  and  best  knowl- 
edge on  the  subject,  and  the  preventive  measures 
advised  are  accurate,  explicit  and  reliable. — The 
American  Journal  of  the  Medical  Sciences,  April,  1884. 

It  excels  any  other  book  which  has  fallen  under 


ou\  observation  on  the  subject  of  which  it  treats. 
It  comprehends  the  nature,  causes  and  preven- 
tion of  disease  from  a  strictly  scientific  stand- 
point. The  American  publishers  have  done  the 
medical  profes.'ion  a  valuable  service  in  laying  it 
before  them.  It  contains  much  with  which  every 
physician  should  be  familiar.  There  is  no  other 
work  in  the  language  in  which  the  information 
here  presented  can  be  found  so  systematically 
arranged  and  intelligently  presented.— TAe  Sani- 
taria-n,  March,  1884. 

This  is  a  book  that  will  surely  find  a  place  on  the 
table  of  every  progressive  physician.  To  the 
medical  profession,  whose  duty  is'quite  as  much  to 
prevent  as  to  cure  disease,  the  book  will  be  a  boon. 
— Boston  Medical  and  Surgical  Journal,  Mar.  6,  1884. 

The  treatise  contains  a  vast  amount  of  solid,  valu- 
able hygienic  miormaXiou.— Medical  and  Surgical 
Reporter,  Feb.  23, 1884. 


JEEAMTSHOItNE,  MENHY,  M.  D.,  LL,  D., 

Formerly  Professor  of  Hygiene  in  the  University  of  Pennsylvania,  and  Professor  of  Physiology  and 
Diseases  of  Children  in  the  Woman's  Medical  College  of  Pennsylvania. 

A  Household  Manual  of  Medicine,  Surgery,  Nursing  and  Hygiene: 

For  Daily  Use  in  the  Preservation  of  Health  and  Care  of  the  Sick  and  Injured,  with  an 
Introductory  Outline  of  Anatomy  and  Physiology.  In  one  very  handsome  royal  octavo 
volume  of  946  pages,  with  8  plates  and  283  engravings.  Cloth,  §4.00 ;  very  handsome 
half  Morocco,  $5.00. 

BABTSOZOW,  BOBEBTS,  A.  M.,  M,  2>.,  ii.  JD,, 

Prof,  of  Materia  Medica  and  General  Therapeutics  in  the  Jefferson  Med.  Coll.  of  Phila.,  etc. 

Medical  Electricity.  A  Practical  Treatise  on  the  Applications  of  Electricity 
to  Medicine  and  Surgery.  New  (third)  edition.  In  one  very  handsome  octavo  volume  of 
300  pages,  with  about  125  illustrations.    Shortly. 

A  notice  of  the  previous  edition  is  appended. 


A  most  excellent  work,  addressed  by  a  practi- 
tioner to  his  fellow-practitioners,  and  therefore 
thoroughly  practical.  The  work  now  before  us 
has  the  exceptional  merit  of  clearly  pointing  out 
where  the  benefits  to  be  derived  from  electricity 
must  come.  It  contains  all  and  everything  that 
the  practitioner  needs  in  order  to  understand  in- 
telligently the  nature  and  laws  of  the  agent  he  is 
making  use  of,  and  for  its  proper  application  in 


practice.  In  a  condensed,  practical  form,  it  pre- 
sents to  the  physician  all  that  he  would  wish  to 
remember  after  perusing  a  whole  library  on  medical 
electricity,  including  the  results  of  the  latest  in- 
vestigations. It  is  the  book  for  the  practitioner, 
and  tne  necessity  for  a  second  edition  proves  that 
it  has  been  appreciated  by  the  profession.— Pfej/s^ 
dan  and  Surgeon,  Dec.  1882. 


TSB  TBAB-BOOK  OF  TBBATMENT  FOB  1886. 

A  Comprehensive  and  Critical  Review  for  Practitioners  of  Medi- 
cine.    In  one  12mo.  volume  of  309  pages,  bound  in  limp  cloth,  $1.25.     Just  ready. 

This  work  presents  not  only  a  complete  classified  account  of  all  the  more  important 
•  advances  made  in  the  treatment  of  disease  during  the  year  ending  September  30,  1886, 
but  also  a  critical  estimate  of  the  same  by  competent  authorities.  Each  department  of 
practice  is  fully  and  concisely  treated,  and  into  the  consideration  of  each  subject  enter 
such  allusions  to  recent  pathological  and  clinical  work  as  bear  directly  upon  treatment, 

4e.*4{.  For  special  commutations  with  periodicals  see  page  3. 

TME  TEAB-BOOK  OF  TBEATMENT  FOB  1885, 

Similar  to  that  of  1886  above.     12mo.,  320  pages.     Limp  cloth,  §1.25. 

SCSBEIBEB,  BB.  JOSEFS, 

A  Manual  of  Treatment  by  Massage  and  Methodical  Muscle  Ex- 
ercise. Translated  by  Walter  Mendelson,  M.  D.,  of  New  York.  In  one  handsome 
octavo  volume  of  about  300  pages,  with  about  125  fine  engravings.     In  press. 


8TURGES'  INTRODUCTION  TO  THE  STUDY 
OF  CLINICAL  MEDICINE.  Being  a  Guide  to 
the  Investigation  of  Disease.  In  one  handsome 
12mo.  volume  of  127  pages.    Cloth,  81.25. 

DAVIS'  CLINICAL  LECTURES  ON  VARIOUS 
IMPORTANT  DISEASES.  By  N.  S.  Davis, 
M.  D.  Edited  by  Frank  H.  Davis,  M.  D.  Second 
edition.    12mo.  287  pages.    Cloth,  81.75. 

TODD'S  CLINICAL  LECTURES  ON  CERTAIN 
ACUTE  DISEASES.  In  one  octavo  volume  of 
320  pages.    Cloth,  $2.50. 


PAVT'S  TREATISE  ON  THE  FUNCTION  OF  DI- 
GESTION; its  Disorders  and  their  Treatment. 
From  the  second  London  edition.  In  one  octavo 
volume  of  238  pages.    Cloth,  82.00. 

BARLOW'S  MANUAL  OF  THE  PRACTICE  OF 
MEDICINE.  With  additions  by  D.  F.  Condie, 
M.  D.     1  vol.  8vo.,  pp.  603.     Cloth,  82.50. 

CHAMBERS' MANUAL  OF  DIET  AND  REGIMEN 
IN  HEALTH  AND  SICKNESS.  In  one  hand- 
some octavo  volume  of  302  pp.    Cloth,  82.75. 

HOLLAND'S  MEDICAL  NOTES  AND  HEFLEC- 
TIONS.  1  vol.  8vo.,  pp.  493.     Cloth,  83.50. 


18         Lea  Brothers  &  Co.'s  Publications — Throat,  livings.  Heart. 
FLINT,  AUSTIN,  M.  D., 

Professor  of  the  Principles  and  Practice  of  Medicine  in  Bellevue  Hospital  Medical  College,  N.  T. 

A.  Manual  of  Auscultation  and  Percussion ;  Of  the  Physical  Diagnosis  of 
Diseases  of  the  Lungs  and  Heart,  and  of  Thoracic  Aneurism.  Fourth  edition.  In  one 
handsome  royal  12mo.  volume  of  278  pages,  with  14  illustrations.    Cloth,  $1.75.  Just  ready. 


The  student  needs  a  first-class  text-book  in 
which  the  subject  is  fally  esDlained  for  him  to 
study.  Dr.  Flint's  work  is  just  such  a  book.  It 
contains  the  substance  of  the  lessons  which  the 
author  has  for  many  years  given  in  connection 
with   practical   instruction    m  auscultation    and 


percussion  to  private  classes,  composed  of  medical 
students  and  practitioners.  The  fact  that  within 
a  little  more  than  two  years  a  large  edition  of  this 
manual  has  been  exhausted,  is  proof  of  the  favor 
with  which  it  has  been  regarded  by  the  medical 
profession. — Cincinnati  Medical  News,  Feb.  1886. 


BY  THE  SAME  A  UTHOR. 

Physical  Exploration  of  the  Lungs  by  Means  of  Auscultation  and 
Percussion.  Three  lectures  delivered  before  the  Philadelphia  County  Medical  Society, 
1882-83.    In  one  handsome  small  12mo.  volume  of  83  pages.    Cloth,  $1.00. 

A  Practical  Treatise  on  the  Physical  Exploration  of  the  Chest  and 
the  Diagnosis  of  Diseases  Affecting  the  Respiratory  Organs.  Second  and 
revised  edition.     In  one  handsome  octavo  volume  of  591  pages.     Cloth,  $4.50. 

Phthisis:  Its  Morbid  Anatomy,  Etiology,  Symptomatic  Events  and 
Complications,  Fatality  and  Prognosis,  Treatment  and  Physical  Diag- 
nosis ;  In  a  series  of  Clinical  Studies.  In  one  handsome  octavo  volume  of  442  pages. 
Cloth,  $3.50.  

A  Practical  Treatise  on  the  Diagnosis,  Pathology  and  Treatment  of 
Diseases  of  the  Heart.  Second  revised  and  enlarged  edition.  In  one  octavo  volume 
of  550  pages,  with  a  plate.     Cloth,  $4. 

Essays  on  Conservative  Medicine  and  Kindred  Topics.  In  one  very  hand- 
some royal  12mo.  volume  of  210  pages.     Cloth,  $1.38. 


BBOWNE,  LBNNOX,  F.  H.  C.  S,,  Fdin., 

Senior  Surgeon  to  the  Central  London  Throat  and  Ear  Hospital,  etc. 
The  Throat  and  its  Diseases.     Second  American  from  the  second  English  edi- 
tion, thoroughly  revised.     With  200  engravings  and  120  illustrations  in  colors.     In  one 
very  handsome  imperial  octavo  volume  of  about  350  pages.     Shortly. 

GHOSSf  S,  D.f  iHf.D.,  IL.D.f  D.C.i.  Oxon,,  LL.I).  Cantab. 

A  Practical  Treatise  on  Foreign  Bodies  in  the  Air-passages.    In  one 

octavo  volume  of  452  pages,  with  59  illustrations.     Cloth,  $2.75. 

COHEN,  J.  SOUS,  M.  D., 

Lecturer  on  Laryngoscopy  and  Diseases  of  the  Throat  and  Chest  in  the  Jefferson  Medical  College. 

Diseases  of  the  Throat  and  Nasal  Passages.  A  Guide  to  the  Diagnosis  and 
Treatment  of  Affections  of  the  Pharynx,  QEsophagus,  Trachea,  Larynx  and  Nares.  Third 
edition,  thoroughly  revised  and  rewritten,  with  a  large  number  of  new  illustrations.  In 
one  very  handsome  octavo  volume.     Preparing. 

SFIZFB,  CABL,  M,  I)., 

Lecturer  on  Laryngoscopy  in  the  University  of  Pennsylvania. 

A  Handbook  of  Diagnosis  and  Treatment  of  Diseases  of  the  Throat, 
Nose  and  Naso-Pharynx.  Second  edition.  In  one  handsome  royal  12mo.  volume 
of  294  pages,  with  77  illustrations.     Cloth,  $1.75. 

and  there  are  a  valuable  bibliography  and  a  good 
index  of  the  whole.  For  any  one  who  wishes  to 
make  himself  familiar  with  the  practical  manage- 


It  is  one  of  the  best  of  the  practical  text-books 
on  this  subject  with  which  we  are  acquainted.  The 
present  edition  has  been  increased  in  size,  but  its 
eminently  practical  character  has  been  main- 
tained. Many  new  illustrations  have  also  been 
introduced,  a  case-record  sheet  has  been  added, 


ment  of  cases  of  throat  and  nose  disesise,  the  book 
will  be  found  of  great  value. — New  York  Medical 
Journal,  June  9, 1883. 


FULLER  ON  DISEASES  OF  THE  LQNGS  AND 
AIR-PASSAGES.  Their  Pathology,  Physical  Di- 
agnosis, Symptoms  and  Treatment.  From  the 
second  and  revised  English  edition.  In  one 
octavo  volume  of  475  pages.    Cloth,  $3.50. 

BLADE  ON  DIPHTHERIA;  its  Nature  and  Treat> 
ment,  with  an  account  of  the  History  of  its  Pre- 
valence in  various  Countries.  Second  and  revised 
edition.    In  one  12mo.  vol.,  pp.  158.    Cloth,  81.25. 

WALSHE  ON  THE  DISEASES  OF  THE  HEART 
AND  GREAT  VESSELS.    Third  American  edi- 


SMITH  ON  CONSUMPTION ;  its  Early  and  Reme- 
diable Stages.    1  vol.  8vo.,  pp.  253.    Cloth,  82.25. 

LA  ROCHE  ON  PNEUMONIA.  1  vol.  8vo.  of  490 
pages.    Cloth,  S3.00. 

WILLIAMS  ON  PULMONARY  CONSUMPTION; 
its  Nature,  Varieties  and  Treatment.  With  an 
analysis  of  one  thousand  cases  to  exemplify  its 
duration.   In  one  8vo.  vol.  of  303  pp.   Cloth,  82.50. 

JONES'  CLINICAL  OBSERVATIONS  ON  FUNC- 
TIONAL NERVOUS  DISORDERS.  Second  Am- 
erican edition.   In  one  handsome  octavo  volume 


tion.    In  1  vol.  8vo.,  416  pp.    Cloth,  83.00.  I     of  340  pages.    Cloth,  $3.25. 


Lea  Brothers  &  Co.'s  Publications — Nerv.  andMent.  Dis.,  etc.     19 


MOSS,  JAMES,  M.n.,  F.M.C.P,,  ZZ.D., 

Senior  Assistant  Physician  to  the  Manchester  Royal  Infirmary. 

A  Handbook  on  Diseases  of  the  Nervous    System.     In  one  octavo 
volume  of  725  pages,  with  184  illustrations.     Cloth,  $4.50  ;  leather,  $5.50. 
.This  admirable  worli  is  intended  for  students  of  I  the  department  of  medicine  of  which  it  treats. 


medicine  and  for  such  medical  men  as  have  no  time 
for  lengthy  treatises.  In  the  present  instance  the 
duty  of  arranging  the  vast  store  of  material  at  the 
disposal  of  the  author,  and  of  abridging  the  de- 
scription of  the  different  aspects  of  nervous  dis- 
eases, has  been  performed  with  singular  skill,  and 
the  result  is  a  concise  and  philosophical  guide  to 


Dr.  Boss  holds  such  a  high  scientific  position  that 
any  writings  which  bear  his  name  are  naturally 
expected  to  have  the  impress  of  a  powerful  intel- 
lect. In  every  part  this  handbook  merits  the 
highest  praise,  and  will  no  doubt  be  found  of  the 
greatest  value  to  the  student  as  well  as  to  the  prac- 
titioner.— Edinburgh  Medical  Journal,  Jan.  1887. 


MITCHELL,  S.  WEIM,  M,  !>., 

Physician  to  Orthopmdic  Hospital  and  the  Infirmary  for  Diseases  of  the  Nervous  System,  Phila.,  etc. 

Lectures  on  Diseases  of  the  Nervous  System;  Especially  in  Women. 
Second  edition.     In  one  12mo.  volume  of  288  pages.     Cloth,  |1.75. 

No  work  in  our  language  develops  or  displays 
more  features  of  that  many-sided  affection,  hys- 
teria, or  gives  clearer  directions  for  its  differen- 
tiation, or    sounder    suggestions    relative  to  its 


general  management  and  treatment.  The  book 
is  particularly  valuable  in  that  it  represents  in 
the  main  the  author's  own  clinical  studies,  which 
have  been  so  extensive  and  fruitful  as  to  give  his 


teachings  the  stamp  of  authority  all  over  the 
realm  of  medicine.  The  work,  although  written 
by  a  specialist,  has  no  exclusive  character,  and 
the  general  practitioner  above  all  others  will  find 
its  perusal  profitable,  since  it  deals  with  diseases 
which  he  frequently  encounters  and  must  essay 
to  treat. — American  Practitioner,  August,  1885. 


HAMILTON,  ALLAJS^  McLANE,  M,  D., 

Attending  Physician  at  the  Hospital  for  Epileptics  and  Paralytics,  BlackwelVs  Island,  N.  T. 
Nervous  Diseases ;  Their  Description  and  Treatment.     Second  edition,  thoroughly 
revised  and  rewritten.    In  one  octavo  volume  of  598  pages,  with  72  illustrations.    Cloth,  $4. 
When  the  first  edition  of  this  good  book  appeared  |  characterized  this  hookas  the  best  of  its  kind  in 


we  gave  it  our  emphatic  endorsement,  and  the  i 
present  edition  enhances  our  appreciation  of  the  j 
book  and  its  author  as  a  safe  guide  to  students  of  I 
clinical  neurology.  One  of  the  best  and  most  I 
critical  of  English  neurological  journals,  £ram,  has  1 


any  language,  which  is  a  handsome  endorsement 
from  an  exalted  source.  The  improvements  in  the 
new  edition,  and  the  additions  to  it,  will  justify  its 
purchase  even  by  those  who  possess  the  old. — 
Alienist  and  Neurologist,  April,  1882. 


TUKE,  DAJVIEL  HACK,  M,  J),, 

Joint  Author  of  The  Manual  of  Psychological  Medicine,  etc. 

Illustrations  of  the  Influence  of  the  Mind  upon  the  Body  in  Health 
and  Disease.  Designed  to  elucidate  the  Action  of  the  Imagination.  New  edition. 
Thoroughly  revised  and  rewritten.  In  one  handsome  octavo  volume  of  467  pages,  with 
two  colored  plates.     Cloth,  $3.00. 

method  of  interpretation.  Guided  by  an  enlight- 
ened deduction,  the  author  has  reclaimed  for 
science  a  most  interesting  domain  in  psychology, 
previously  abandoned  to  charlatans  and  empirics. 
This  book,  well  conceived  and  well  written,  must 
commend  itself  to  every  thoughtful  understand- 
ing.— New  York  Medical  Journal,  September  6, 1884. 


It  is  impossible  to  peruse  these  interesting  chap- 
ters without  being  convinced  of  the  author's  per- 
fect sincerity,  impartiality,  and  thorough  mental 
grasp.  Dr.  Take  has  exhibited  the  requisite 
amount  of  scientific  address  on  all  occasions,  and 
the  more  intricate  the  phenomenathe  more  firmly 
has  he  adhered  to  a  physiological  and  rational 


CLOUSTOJ^,  THOMAS  S.,  M.  I),,  F,  B,  C.  I*,,  i.  B,  C.  S,, 

Lecturer  on  Mental  Diseases  in  the  University  of  Edinburgh. 

Clinical  Lectures  on  Mental  Diseases.  With  an  Appendix,  containing  an 
Abstract  of  the  Statutes  of  the  United  States  and  of  the  Several  States  and  Territories  re- 
lating to  the  Custody  of  the  Insane.  By  Charles  F.  Folsom,  M.  D.,  Assistant  Professor 
of  Mental  Diseases,  Med.  Dep.  of  JEIarvard  Univ.  In  one  handsome  octavo  volume  of  541 
pages,  with  eight  lithographic  plates,  four  of  which  are  beautifully  colored.     Cloth,  $4. 

The  practitioner  as  well  as  the  student  will  ac- 
cept the  plain,  practical  teaching  of  the  author  as  a 
forward  step  in  the  literature  of  insanity.  It  is 
refreshing  to  find  a  physician  of  Dr.  Clouston's 


experience  and  high" reputation  giving  the  bed- 
side notes  upon  which  his  experience  has  been 
founded  and  his  mature  judgment  established. 
Such  clinical  observations  cannot  but  be  useful  to 


the  general  practitioner  in  guiding  him  to  a  diag- 
nosis and  indicating  the  treatment,  especially  in 
many  obscure  and  doubtful  cases  of  mental  dis- 
ease. To  the  American  reader  Dr.  Folsom's  Ap- 
pendix adds  greatly  to  the  value  of  the  work,  and 
will  make  it  a  desirable  addition  to  every  library. 
— American  Psychological  Journal,  July,  1884. 


S^'Dr.  Folsom's  Abstract  may  also  be  obtained  separately  in  one  octavo  volume  of 
108  pages.     Cloth,  $1.50.     

SAVAGE,  GEOMGE  H.,  M.  I>,, 

Lecturer  on  Mental  Diseases  at  Cfuy's  Hospital,  London. 

Insanity  and  Allied  Neuroses,  Practical  and  Clinical.    In  one  12mo.  vol. 
of  551  pages,  with  18  illus.     Cloth,  $2.00.     See  Series  of  Clinical  Manuals,  page  4. 

JPLATFAIB,  W.  S.,  M.  H.,  F,  M,  O.  1*., 

The  Systematic  Treatment  of  Nerve  Prostration  and  Hysteria.    In 

one  handsome  small  12mo.  volume  of  97  pages.     Cloth,  $1.00. 

Blandford  on  Insanity  and  its  Treatment:   Lectures  on  the  Treatment, 

Medical  and  Legal,  of  Insane  Patients.    In  one  very  handsome  octavo  volume. 


20 


Lea  Brothers  &  Co.'s  Publications — Surgery. 


ASSBUJRST,  JOSN,  Jr.,  M.  !>., 

Professor  of  Clinical  Surgery,  Univ.  of  Penna.,  Surgeon  to  the  Episcopal  Hospital,  Philadelphia. 

The  Prinoiples  and  Practice  of  Surgery.  New  (fourth)  edition,  enlarged 
and  revised.  In  one  large  and  handsonae  octavo  volume  of  1114  pages,  with  597  illustra- 
tions.    Cloth,  $6  ;  leather,  $7  ;  half  Eussia,  §7.50. 

Every  advance  in  surgery  worth  notice,  chroni- 
cled in  recent  literature,  has  been  suitably  recog- 
nized and  noted  in  its  proper  place.  Suffice  it  to 
sa}'',  we  regard  Ashhurst's  Surgery,  as  now  pre 


As  with  Erichsen  so  with  Ashhurst,  its  position 
in  professional  fairor  is  established,  and  one  has 
now  but  to  notice  the  changes,  if  any,  in  theory 
and  practice,  that  are  apparent  in  the  present 
as  compared  with  the  preceding  edition,  published 
three  years  ago.  The  work  has  been  brought  well 
up  to  date,  and  is  larger  and  better  illustrated  than 
before,  and  its  author  may  rest  assured  that  it  will 
certainly  have  a  "continuance  of  the  favor  with 
which  it  has  heretofore  been  received."— T/i.e 
American  Journal  of  the  Medical  Sciences,  Jan.  1886. 


sented  in  the  fourth  edition,  as  tiie  best  single 
volume  on  surgery  published  in  the  English  lan- 
guage, valuable  alike  to  the  student  and  the  prac- 
titioner, to  the  one  as  a  text-book,  to  the  other  as 
a  manual  of  practical  surgery.  With  pleasure  we 
give  this  volume  our  endorsement  in  full. — New 
Orleans  Medical  and  Surgical  Journal,  Jan.,  1886. 


GBOSSf  S.  n,,  M.  JD.f  LL.  jD.,  JD,  C,  L.  Oxon.,  LL,  D. 
Cantab. f 

Emeritus  Professor  of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia. 
A  System  of  Surgery:    Pathological,   Diagnostic,  Therapeutic  and  Operative. 
Sixth  edition,  thoroughly  revised  and  greatly  improved.     In  two  large  and  beautifully- 
printed  imperial  octavo  volumes  containing  2382  pages,  illustrated  by  1623  engravings. 
Strongly  bound  in  leather,  raised  bands,  $15  ;  half  Russia,  raised  bands,  $16. 

Dr.  Gross'  System  of  Surgery  has  long  been  the  |      His  System  of  Surgery,  which,  since  its  first  edi- 
standard  work  on  that  subject  for  students  and 
practitioners. — London  Lancet,  May  10,  188-1. 

The  work  as  a  whole  needs  no  commendation. 
Many  years  ago  it  earned  for  itself  the  enviable 
reputation  of  the  leading  American  work  on  sur- 
gery, and  it  is  still  capable  of  maintaining  that 
standard.  A  considerable  amount  of  new  material 
has  been  introduced,  and  altogether  the   distin- 

fuished  author  has  reason  to  be  satisfied  that  he 
as  placed  the  work  fully  abreast  of  the  state  of 
our  knowledge.— ilfed.  Record,  Nov.  18, 1882. 


tion  in  1859,  has  been  a  standard  work  in  this 
country  as  well  as  in  America,  in  "the  whole 
domain  of  surgery,"  tells  how  earnest  and  labori- 
ous and  wise  a  surgeon  he  was,  how  thoroughly 
he  appreciated  the  work  done  by  men  in  other 
countries,  and  how  much  he  contributed  to  pro- 
mote the  science  and  practice  of  surgery  in  his 
own.  There  has  been  no  man  to  whom  America 
is  so  much  indebted  in  this  respect  as  the  Nestor 
of  surgery. — British  Medical  Journal,  May  10, 1884. 


GOULD,  A.  FBAMCE,  M.  S.,  M.  B,,  F.  M,  C.  S,, 

Assistant  Surgeon  to  Middlesex  Hospital. 

Elements  of  Surgical  Diagnosis.    In  one  pocket-size  12mo.  volume  of  589 

pages.     Cloth,  $2.00.     See  Students'  Series  of  Manuals,  page  4. 


This  book  will  be  found  to  be  a  most  useful 
guide  for  the  hard-worked  practitioner.  Mr. 
Gould's  style  is  eminently  clear  and  precise,  and 
we  can  cordially  recommend  the  manual  as  being 
the  outcome  of  the  efforts  of  an  honest  and  thor- 
oughly practical  surgeon.— TAe  Medical  News,  Jan. 
24,  1885. 


This  is  a  capital  little  book,  written  by  a  prac- 
tical man  on  a  very  practical  subject.  The  topics 
are  very  systematically  and  succinctly  arranged, 
are  tersely  presented,  and  the  points  of  diagnosis 
very  intelligently  discussed.  It  will  be  found  to 
be  of  the  greatest  amount  of  help  both  to  teacher 
and  stwie-'-it.— Medical  Record,  Feb,  28,  1885. 


GIBWET,  V,  J».,  M,  J>., 

Surgeon  to  the  Orthopaedic  Hospital,  New  York,  etc. 
Ortiiopsedic  Surgery.    For  the  use  of  Practitioners  and  Students, 
some  octavo  volume,  profusely  illustrated.     Preparing. 


In  one  hand- 


DBUITTf  MOBBHTf  M.  M.  O.  S,,  etc. 

The  Principles  and  Practice   of  Modern    Surgery.    From  the  eighth 

London  edition.     In  one  8vo.  volume  of  687  pages,  with  432  illus.     Cloth,  $4 ;  leather,  $5. 


BOBEBTS,  JOSJS^  B,,  A,  M.,  M.  D., 

Lecturer  on  Anatomy  and  on  Operative  Surgery  at  the  Philadelphia  School  of  Anatomy. 

The  Principles  and  Practice  of  Modern  Surgery.  For  the  use  of  Students 
and  Practitioners  of  Medicine  and  Surgery.  In  one  very  handsome  octavo  volume  of  about 
500  pages,  with  many  illustrations.     Preparing. 

BELLAMY,  EDWABD,  F.  B.  C.  S., 

Surgeon  and  Lecturer  on  Surgery  at  Charing  Cross  Hospital,  London. 
Operative  Surgery.     Shortly.     See  Students'  Series  of  Manuals,  page  4. 


PIRRIE'S  PRINCIPLES  AND  PRACTICE  OF 
SURGERY.  Edited  by  John  Neill,  M.  D.  In 
one  8vo.  vol.  of  784  pp.  with  316  illus.     Cloth,  83.75. 

MILLER'S  PRACTICE  OF  SURGERY.  Fourth 
and  revised  American  from  the  last  Edinburgh 
edition.  In  one  large  8vo.  vol.  of  682  pages,  with 
364  illustrations.    Cloth,  $3.75. 


SKEY'S  OPERATIVE  SURGERY.  In  one  vol.  8vo. 
of  661  pages;  with  81  woodcuts.    Cloth,  83.25. 

MILLERS  PRINCIPLES  OF  SURGERY.  Fourth 
Americaen  from  the  third  Edinburgh  edition.  In 
one  8vo.  vol.  of  638  pages,  with  340  illustrations. 
Cloth,  83.75. 


Lea  Brothers  &  Co.'s  Publications — Surgery. 


21' 


MMICHSBN,  JOSJV  E.,  F,  Jt.  S,,  F.  B.  C.  S., 

Professor  of  Surgery  in  University  College,  London,  etc. 

The  Science  and  Art  of  Surgery ;  Being  a  Treatise  on  Surgical  Injuries,  Dis- 
eases and  Operations.  From  the  eighth  and  enlarged  English  edition.  In  two  large  and 
beautiful  octavo  volumes  of  2316  pages,  illustrated  with  984  engravings  on  wood. 
Cloth,  $9;  leather,  raised  bands,  $11 ;  half  Eussia,  raised  bands,  $12. 


In  noticing  the  eighth  edition  of  this  well- 
known  work,  it  would  appear  superfluous  to  say- 
more  than  that  it  has,  like  its  predecessors,  been 
brought  fully  up  to  the  times,  and  is  in  conse- 
quence one  of  the  best  treatises  upon  surgery  that 
has  ever  been  penned  by  one  man.  We  nave  al- 
ways regarded  "The  Science  and  Art  of  Surgery" 
as  one  of  the  best  surgical  text-books  in  the 
English  language,  and  this  eighth  edition  only 
confirms  our  previous  opinion.  We  take  great 
pleasure  in  cordially  commending  it  to  our  read- 
ers.—TAeilfedJcai  News,  April  11,  1885. 

After   being   before   the   profession   for  thirty 


years  and  maintaining  during  that  period  a  re- 
putation as  a  leading  work  on  surgery,  there  is  not 
much  to  be  said  in  the  way  of  comment  or  criti- 
cism. That  it  still  holds  its  own  goes  without  say- 
ing. The  author  infuses  into  it  his  large  experi- 
ence and  ripe  judgment.  Wedded  to  no  school, 
committed  to  no  theory,  biassed  by  no  hobby,  he 
imparts  an  honest  personality  in  his  observations, 
and  his  teachings  are  the  rulings  of  an  impartial 
judge.  Such  men  are  always  safe  guides,  and  their 
works  stand  the  tests  of  time  and  experience. 
Such  an  author  is  Erichsen,  and  such  a  work  is  his 
Surgery.— Medical  Record,  Feb.  21,  1885. 


BBTAJSTT,  THOMAS f  F.  M.  C.  S,, 

Surgeon  and  Lecturer  on  Surgery  at  Gruy's  Hospital,  London. 
The  Practice  of  Surgery.     Fourth  American  from  the  fourth  and  revised  Eng- 
lish edition.     In  one  large  and  very  handsome  imperial  octavo  volume  of  1040  pages,  with 
727  illustrations.     Cloth,  $6.50 ;  leather,  $7.50 ;  half  Russia,  $8.00. 

The  fourth  edition  of  this  work  is  fully  abreast  |  books  for  the   medical  student.     Almost   every 


of  the  times.  The  author  handles  his  subjects 
with  that  degree  of  judgment  and  skill  which  is 
attained  by  years  of  patient  toil  and  varied  ex- 
perience. The  present  edition  is  a  thorough  re- 1 
vision  of  those  which  preceded  it,  with  much  new 
matter  added.  His  diction  is  so  graceful  and 
logical,  and  his  explanations  are  so  lucid,  as  to 
place  the  work  among  the  highest  order  of  text-  i 


topic  in  surgery  is  presented  in  such  a  form  as  to 
enable  the  busy  practitioner  to  review  any  subject 
in  every-day  practice  in  a  short  time.  No  time  is 
lost  with  useless  theories  or  superfluous  verbiage. 
In  short,  the  work  is  eminently  clear,  logical  and 
practical. — Chicago  Medical  Journal  arid  Examiner, 
April,  1886. 


By  the  same  Author. 
Diseases  of  the  Breast.   In  one  12mo.  .volume.   Preparing.   See  Series  of  Clinical 
Manuals,  page  4. 

TMFVFS,  FMFBFMICK,  F,  M.  C.  S,, 

Hunterian  Professor  at  the  Royal  College  of  Surgeons  of  England. 
A  Manual    of   Surgery.     In  Treatises  by  Various  Authors.     In  three  12mo. 
volumes,  containing  1866  pages,  with  213  engravings.     Price  per  volume,  cloth,  $2.     See 
Students'  Series  of  Manuals,  page  4. 


We  have  here  the  opinions  of  thirty-three 
authors,  in  an  eneyclopEedic  form  for  easy  and 
ready  reference.  The  three  volumes  embrace 
every  variety  of  surgical  affections  likely  to  be 
met  with,  the  paragraphs  are  short  and  pithy,  and 
the  salient  points  and  the  beginnings  of  new  sub- 
jects are  always  prmted  in  extra-heavy  type,  so 
that  a  person  may  find  whatever  information  he 
may  be  in  need  of  at  a  moment's  glance.  The 
authors  have  confined  themselves  to  stating  only 
what  is  really  important  to  know,  free  from  all 
difi'useness  and  unnecessary  adornment. — Cincin- 
nati Lancet-Clinic,  August  21,  1886. 


in  the  choice,  arrangement  and  logical  sequence  of 
the  subjects.  Every  topic,  as  far  as  observed,  is 
treated  with  a  fulness  of  essential  detail,  which  is 
somewhat  surprising  in  view  of  the  necessary 
limitations  of  space.  Another  characteristic  of  the 
work  is  the  well-nigh  universal  acceptance  of  mod- 
ern and  progressive  views  of  pathology  and  treat- 
ment. The  entire  work  is  conceived  and  executed 
in  a  scientific  spirit.  It  is  conservative  without 
bigotry  and  contains  the  bone  and  marrow  of  mod- 
ern surgery.  Taking  the  manual  in  its  entirety, 
it  unquestionably  fills  a  place  in  the  surgeon's 
library  which  would  otherwise  be  untenanted. — 


The  hand  of  Mr.  Treves  is  evident  throughout  |  Annals  of  Surgery,  Oct.  1886. 


BUTLIJV,  MENHY  T,,  F,  It,  C.  S., 

Assistant  Surgeon  to  St.  Bartholomew's  Hospital,  London. 

Diseases    of   the   Tongue.     In  one  12mo.  volume  of  456  pages,  with  8  colored 
plates  and  3  woodcuts.     Cloth,  $3.50.     See  Series  of  Clinical  Manuals,  page  4. 


Twenty-four  excellent  colored  lithographs,  illus- 
trating the  diseased  condition  of  the  organ  have 
been  added,  which  much  increase  the  value  of 
the  book.  Mr.  Butlin  has  written  a  work  of  great 
merit,  and  the  book  is  a  valuable  addition  to  sur- 
gical literature. — New  York  Medical  Journal,  July 
17,  1886. 

The  language  of  the  text  is  clear  and  concise. 


The  author  has  aimed  to  state  facts  rather  than  to 
express  opinions,  and  has  compressed  within  the 
compass  of  this  small  volume  the  pathology,  etiol- 
ogy, etc.,  of  diseases  of  the  tongue  that  are  incon- 
veniently scattered  through  general  works  on  sur- 
gery and  the  practice  of  medicine.  The  physician 
and  surgeon  will  appreciate  its  value  as  an  aid  and 
guide. — Physician  and  Surgeon,  Sept.  1886. 


TMEVFS,  FMFDFRICK,  F.  M.  C.  S., 

Surgeon  to  and  Lecturer  on  Surgery  at  the  London  Hospital. 

Intestinal  Obstruction.    In  one  pocket-size  12mo.  volume  of  522  pages,  with  60 


illustrations.  Limp  cloth,  blue  edges,  $2.00 

A  standard  work  on  a  subject  that  has  not  been 
80  comprehensively  treated  by  any  contemporary 
English  writer.  Its  completeness  renders  a  full 
review  difficult,  since  every  chapter  deserves  mi- 
nute attention,  and  it  is  impossible  to  do  thorough 


See  Series  of  Clinical  Manuals,  page  4. 
justice  to  the  author  in  a  few  paragraphs.  Intes- 
tinal Obstruction  is  a  work  that  will  prove  of 
equal  value  to  the  practitioner,  the  student,  the 
pathologist,  the  physician  and  the  operating  sur- 
geon.— British  Medical  Journal,  Jan.  31,  1885. 


BALL,  CMABLFS  B.,  M.  Ch,,  Dub,,  F,  M.  C.  S.  E., 

Surgeon  and  Teacher  at  Sir  P.  Dun's  Hospital,  Dublin. 

Diseases  of  the  Rectum  and  Anus.    In  one  12mo.  volume  of  550  pages. 
Preparing.     See  Series  of  Clinical  Manuals,  page  4. 


22      Lea  Brothers  &  Co.'s  Publications — Surgery*  Frac,  Disloc. 
SOLMES,  TIMOTHY,  M,  A., 

Surgeon  and  Lecturer  on  Surgery  at  St.  George's  Hospital,  London. 

A  System  of  Surgery ;  Theoretical  and  Practical.  IN  TKEATISES  BY 
VAEIOUS  AUTHORS.  American  edition,  thoroughly  revised  and  re-edited 
by  John  H.  Packard,  M.  D.,  Surgeon  to  the  Episcopal  and  St.  Joseph's  Hospitals, 
Philadelphia,  assisted  by  a  corps  of  thirty-three  of  the  most  eminent  American  surgeons. 
In  three  large  and  very  handsome  imperial  octavo  volumes  containing  3137  double- 
columned  pages,  with  979  illustrations  on  wood  and  13  lithographic  plates,  beautifully 
colored.  Price  per  set,  cloth,  $18.00;  leather,  f  21.00;  half  Russia,  |22.50.  Sold  only  by 
subscription. 

HAMILTON,  FBAWK  H,,  M.  D.,  LI,  jD., 

Surgeon  to  Bellevue  Hospital,  New  York. 

A  Practical  Treatise  on  Fractures  and  Dislocations.  Seventh  edition 
thoroughly  revised  and  much  improved.  In  one  very  handsome  octavo  volume  of  998 
pages,  with  379  illustrations.  Cloth,  |5.50 ;  leather,  |6.50 ;  very  handsome  half  Russia, 
open  back,  $7.00 


It  is  about  twenty-five  years  ago  since  the  first 
edition  of  this  great  work  appeared.  The  edition 
now  issued  is  the  seventh,  and  this  fact  alone  is 
enough  to  testify  to  the  excellence  of  it  in  all  par- 
ticulars. Books  upon  special  subjects  do  not 
usually  command  extended  sale,  but  this  one  is 
without  a  rival  in  any  language.  It  is  essentially 
a  practical  treatise,  and  it  gathers  within  its  covers 
almost  everything  valuable  that  has  been  written 
about  fractures  and  dislocations.  The  principles 
and  methods  of  treatment  are  very  fully  given. 
The  book  is  so  well  known  that  it  does  not  require 


any  lengthened  review.  We  can  only  say  that  it 
is  still  unapproached  as  a  treatise,  and  that  it  is  a 
proof  of  the  zeal  and  industry  and  great  ability  of 
its  distinguished  author. — The  Dublin  Journal  of 
Medical  Science,  Feb.  1886. 

His  famous  treatise  on  Fractures  and  Disloca- 
tions, published  first  in  1860,  is  justly  regarded  as 
the  best  book  on  that  subject  in  existence.  It  has 
now  run  through  seven  editions,  and  has  been 
translated  into  French  and  German. — Medical 
Record,  Aug.  U,  1886. 


SMITH,  STEPHEN,  M.  H., 

Visiting  Surgeon  to  Bellevue  and  St.  Vincent's  Hospitals,  N.  Y. 

The  Principles  and  Practice  of  Operative  Surgery.  New  (second)  and 
thoroughly  revised  edition.  In  one  very  handsome  octavo  volume  of  892  pages,  with 
1005  illustrations.     Cloth,  $4.00;  leather,  $5.00.     Just  ready. 

EXTRACT  FROM  THE  PREFACE  TO  THE  SECOND  EDITION. 

This  work  was  first  published  in  1879,  and  although  there  have  been  repeated  large 
issues  since  that  date,  there  has  been  no  change  whatever  in  the  text  until  the  present, 
which  must  therefore  be  regarded  as  the  second  and  only  revised  edition.  To  make  the 
work  a  proper  exponent  of  the  present  state  of  Operative  Surgery  has  required  a  complete 
revision  of  nearly  the  entire  text.  This  has  been  carefully  performed,  and  the  author  has 
the  satisfaction  of  believing  that  the  work  now  embraces  the  latest  advances  in  the  field 
of  new  operations,  and  that  the  details  of  the  most  approved  antiseptic  methods  have 
been  placed  in  such  a  light  that  they  may  be  easily  mastered  and  utilized  by  every 
practitioner. 

STIMSON,  LEWIS  A,,  B.  A,,  M.  I),, 

Professor  of  Pathological  Anatomy  at  the  University  of  the  City  of  New  York,  Surgeon  and  Curator 
to  Bellevue  Hospital,  Surgeon  to  the  Presbyterian  Hospital,  New  York,  etc. 
A  Manual  of  Operative  Surgery.     New  (second)  edition.     In  one  very  hand- 
some royal  12mo.  volume  of  503  pages,  with  342  illustrations.     Cloth,  $2.50.     Just  ready. 

etfected  in  operative  methods  and  procedures  by 
the  antiseptic  system,  and  has  added  an  account 
of  many  new  operations  and  variations  in  the 


There  is  always  room  for  a  good  book,  so  that 
while  many  works  on  operative  surgery  must  be 
considered  superfluous,  that  of  Dr.  Stimson  has 
held  its  own.  The  author  knows  the  difficult  art 
of  condensation.  Thus  the  manual  serves  as  a 
work  of  reference,  and  at  the  same  time  as  a 
handy  guide.  It  teaches  what  it  professes,  the 
steps  of  operations.  In  this  edition  Dr.  Stimson 
has  sought  to  indicate  the  changes  that  have  been 


steps  of  older  operations.  We  do  not  desire  to 
extol  this  manual  above  many  excellent  standard 
British  publications  of  the  same  class,  siill  we  be- 
lieve that  it  contains  much  that  is  worthy  of  imi- 
tation.— British  Medical  Journal,  Jan.  22, 1887. 


By  the  same  Author. 
A  Practical  Treatise  on  Fractures.    In  one  very  handsome  octavo  volume  of 

598  pages,  with  360  beautiful  illustrations.     Cloth,  $4.75 ;  leather,  $5.75. 


The  author  has  given  to  the  medical  profession 
in  this  treatise  on  fractures  what  is  likely  to  be- 
come a  standard  work  on  thesubject.  Itis  certainly 
not  surpassed  by  any  work  written  in  the  English, 
or,  for  that  matter,  any  other  language.  The  au- 
thor tells  us  in  a  short,  concise  and  comprehensive 
manner,  all  that  is  known  about  his  subject.  There 
is  nothing  scanty  or  superficial  about  it,  as  in  most 
other  treatises ;  on  the  contrary,  everything  is  thor- 


ough. The  chapters  on  repair  of  fractures  and  their 
treatment  show  him  not  only  to  be  a  profound  stu- 
dent, but  likewise  a  practical  surgeon  and  patholo- 
gist. His  mode  of  treatment  of  the  different  fract- 
ures is  eminently  sound  and  practical.  We  consider 
this  work  one  of  the  best  on  fractures  ;  and  it  will 
be  welcomed  not  onlv  as  a  text-book,  but  also  by 
the  surgeon  in  full  practice.— iV^.  O.  Medical  and 
Surgical  Journal,  March,  1883. 


MARSH,  HOWARD,  F,  R,  C.  S,, 

Senior  Assistant  Surgeon  to  and  Lecturer  on  Anatomy  at  St.  Bartholomew's  Hospital,  London. 
Diseases  of  the  Joints.     In  one  12mo.  volume  of  468  pages,  with  64  woodcuts 
and  a  colored  plate.     Cloth,  $2.00.     Just  ready.     See  Series  of  Clinical  Manuals,  page  4. 

FICK,  T,  PICKERING,  F,  R.  C,  S., 

Surgeon  to  and  Lecturer  on  Surgery  at  St.  George's  Hospital,  London. 

Fractures  and  Dislocations.     In  one  12mo,  volume  of  530  pages,  with  93 
illustrations.    Limp  cloth,  2.00.    See  Series  of  Clinical  Manuals,  page  4. 


Lea  Brothers  &  Co.'s  Publications — Otol.,  Ophthal. 


23 


BVUNETT,  CSARLES  S,,  A,  M.,  M,  D., 

Professor  of  Otology  in  the  Philadelphia  Polyclinic ;  President  of  the  American  Otological  Society. 

The  Ear,  Its  Anatomy,  Physiology  and  Diseases.  A  Practical  Treatise 
for  the  use  of  Medical  Students  and  Practitioners.  New  (second)  edition.  In  one  handsome 
octavo  volume  of  580  pages,  with  107  illustrations.   Cloth,  $4.00 ;  leather,  $5.00. 


We  note  with  pleasure  the  appearance  of  a  second 
edition  of  this  valuable  work.  When  it  first  came 
out  it  was  accepted  by  the  profession  as  one  of 
the  standard  works  on  modern  aural  surgery  in 
the  English  language;  and  in  his  second  edition 
Dr.  Burnett  has  fully  maintained  his  reputation, 
for  the  book  is  replete  with  valuable  information 
and  suggestions.    The  revision  has  been  carefully 


carried  out,  and  much  new  matter  added.  Dr. 
Burnett's  work  must  be  regarded  as  a  very  valua- 
ble contribution  to  aural  surgery,  not  only  on 
account  of  its  comprehensiveness,  but  because  it 
contains  the  results  of  the  careful  personal  observa- 
tion and  experience  of  this  eminent  aural  surgeon. 
— London  Lancet,  Feb.  21, 1885. 


JPOLITZER,  AID  AM, 

Imperial- Royal  Prof,  of  Aural  Therap.  in  the  Univ.  of  Vienna. 

A  Text-Book  of  the  Ear  and  its  Diseases. 
quest,  by  James  Pattekson  Cassells,  M.  D.,  M.  E.  C.  S. 


ume  of  800  pages,  with  257  original  illustrations.     Cloth,  $5.50. 


Translated,  at  the  Author's  re- 
in one  handsome  octavo  vol- 


The  work  itself  we  do  not  hesitate  to  pronounce 
the  best  upon  the  subject  of  aural  diseases  which 
has  ever  appeared,  systematic  without  being  too 
diffuse  on  obsolete  subjects,  and  eminently  prac- 
tical in  every  sense.  The  anatomical  descriptions 
of  each  separate  division  of  the  ear  are  admirable, 
and  profusely  illustrated  by  woodcuts.  They  are 
followed  immediately  by  the  physiology  of  the 


section,  and  this  again  by  the  pathological  physi- 
ology, an  arrangement  which  serves  to  keep  up  the 
interest  of  the  student  by  showing  the  direct  ap- 
plication of  what  has  preceded  to  the  study  of  dis- 
ease. The  whole  work  can  be  recommended  as  a 
reliable  guide  to  the  student,  and  an  efficient  aid 
to  the  practitioner  in  his  treatment. — Boston  Med- 
ical and  Surgical  Journal,  June  7, 1883. 


JULEB,  HEJSTtT  E.,  E.  M.  C,  S., 

Senior  AssH  Surgeon, Royal  Westminster  Ophthalmic  Hosp. ;  late  Clinical  AssH,  Moorjields,  London. 

A  Handbook  of  Ophthalmic  Science  and  Practice.  In  one  handsome 
octavo  volume  of  460  pages,  with  125  woodcuts,  27  colored  plates,  selections  from  the 
Test-types  of  Jaeger  and  Snellen,  and  Holmgren's  Color-blindness  Test.  Cloth,  $4.50 ; 
leather,  $5.50. 


This  work  is  distinguished  by  the  great  num- 
ber of  colored  plates  which  appear  in  it  for  illus- 
trating various  pathological  conditions.  They  are 
very  beautiful  in  appearance,  and  have  been 
executed  with  great  care  as  to  accuracy.  An  ex- 
amination of  the  work  shows  it  to  be  one  of  high 
standing,  one  that  will  be  regarded  as  an  authority 
among  ophthalmologists.  The  treatment  recom- 
mended is  such  as  the  author  has  learned  from 
actual  experience  to  be  the  best. — Cincinnati  Medi- 
cal News,  Dee.  1884. 

It  presents  to  the  student  concise  descriptions 


and    typical    illustrations    of  all    important   eye 
affections,  placed  in  juxtaposition,    so  as  to  be 

f  rasped  at  a  glance.  Beyond  a  doubt  it  is  the 
est  illustrated  handbook  of  ophthalmic  science 
which  has  ever  appeared.  Then,  what  is  still 
better,  these  illustrations  are  nearly  all  original. 
We  have  examined  this  entire  work  with  great 
care,  and  it  represents  the  commonly  accepted 
views  of  advanced  ophthalmologists.  We  can  most 
heartily  commend  this  book  to  all  medical  stu- 
dents, practitioners  and  specialists.  —  Detroit 
Lancet,  Jan.  1885. 


CABTEB,  M,  BMUDENELL,   &  EJROST,  W,  ADAMS, 

F,  M.  C.  S.,  F,  M.  a  S., 

Ophthalmic  Surgeon  to  and  Lecturer  on  Oph-  Assistant  Ophthalmic  Surgeon  to  and  Joint 

thalmic    Surgery   at    St.   George's   Hospital,  Lecturer  on  Ophthalmic  Surgery   at   St. 

London.  George's  Hospital,  London. 

Ophthalmic  Surgery.  In  one  12mo.  volume  of  about  400  pages.  Preparing. 
See  Series  of  Clinical  Manuals,  page  4. 

WORJRIS,  WM,  F.,  M.  D.,  and  OLIVER,  CSAS.  A.,  M.  D, 

Clin.  Prof,  of  Ophthalmology  in  Univ.  of  Pa,. 

A  Text-Book  of  Ophthalmology.     In  one  octavo  volume  of  about  500  pages, 

with  illustrations.     Preparing. 

WELL^,  J.  SOELBEBG,  F,  It,  C,  S,, 

Professor  of  Ophthalmology  in  King's  College  Hospital,  London,  etc. 

A  Treatise  on  Diseases  of  the  Eye.  New  (fifth)  American  from  the  third 
London  edition.  Thoroughly  revised,  with  copious  additions,  by  L.  Webster  Fox,  M.  D. 
In  one  large  octavo  volume  of  about  850  pages,  with  about  275  illustrations  on  wood,  six 
colored  plates,  and  selections  from  the  Test-types  of  Jaeger  and  Snellen.     Preparing. 

NETTLESMIF,  EDWAMD,  F,  It,  C,  S., 

Ophthalmic  Surg,  and  Lect.  on  Ophth.  Surg,  at  St.  Thomas'  Hospital,  London. 

The  Student's  Guide  to  Diseases  of  the  Eye.  Second  edition.  With  a  chap- 
ter on  the  Detection  of  Color-Blindness,  by  William  Thomson,  M.  D.,  Ophthalmologist 
to  the  Jefferson  Medical  College.  In  one  royal  12mo.  volume  of  416  pages,  with  138 
illustrations.     Cloth,  $2.00. 

BMOWNE,  EnGAB  A,, 

Surgeon  to  the  Liverpool  Eye  and  Ear  Infirmary  and  to  the  Dispensary  for  Skin  Diseases. 
How  to  Use  the  Ophthalmoscope.     Being  Elementary  Instructions  in  Oph- 
thalmoscopy, arranged  for  the  use  of  Students.     In  one  small  royal  12mo.  volume  of  116 
pages,  with  35  illustrations.     Cloth,  $1.00. 


LAURENCE  AND  MOON'S  HANDY  BOOK  OF 
OPHTHALMIC  SURGERY,  for  the  use  of  Prac- 
titioners. Second  edition.  In  one  octavo  vol- 
ume of  227  pages,  with  65  Illust.    Cloth,  $2.75. 


LAWSON  ON  INJURIES  TO  THE  EYE,  ORBIT 
AND  EYELIDS:  Their  Immediate  and  Remote 
Effects.    8  TO.,  404  pp.,  92  illus.    Cloth,  83.50. 


24    Lea  Brothers  &  Co.'s  Publications — Urin.  Dis.,  Dentistry,  etc. 
HOBJEBTS,  WILLIAM,  M,  J)., 

Lecturer  on  Medicine  in  the  Manchester  School  of  Medicine,  etc. 

A  Practical  Treatise  on  Urinary  and  Henal  Diseases,  including  Uri- 
nary Deposits.  Fourth  American  from  the  fourth  London  edition.  In  one  hand- 
some octavo  volume  of  609  pages,  with  81  illustrations.     Cloth,  $3.50. 

The  previous  editions  of  this  book  have  made  it  !  The  peculiar  value  and  finish  of  the  book  are  in 
so  familiar  to  and  so  highly  esteemed  by  the  med- ' 
ical  public,  that  little  more  is  necessary  than  a 
mere  announcement  of  the  appearance  of  this, 
their  successor.  But  it  is  pleasant  to  be  able  to 
say  that,  good  as  those  vpere,  this  is  still  better. 
In  fact,  we  think  it  may  be  said  to  be  the  best  book 
in  print  on  the  subject  of  which  it  treats. — The 
American  Journal  of  the  Medical  Sciences. — Jan.  1886. 


a  measure  derived  from  its  resolute  maintenance 
of  a  clinical  and  practical  character.  It  is  an  un- 
rivalled exposition  of  everything  which  relates 
directly  or  indirectly  to  the  diagnosis,  prognosis 
and  treatment  of  urinary  diseases,  and  possesses 
a  completeness  not  found  elsewhere  in  our  lan- 
guage in  its  account  of  the  different  affections. — 
The  Manchester  Medical  Chronicle,  July,  1885. 


BUnDT,   CMABLES   TF.,  M.  />. 

Bright's  Diseas%and  Allied  Disorders.    In  one  octavo  volume  of  288  pages, 
with  illustrations.     Cloth,  $2.    Just  ready. 

The  object  of  this  work  is  to  "furnish  a  system- 
atic, practical  and  concise  description  of  the 
pathology  and  treatment  of  the  chief  organic 
diseases  of  the  kidney  associated  with  albuminu- 
ria, which  shall  represent  the  most  recent  ad- 
vances in  our  knowledge  on  these  subjects  ; "  and 
this  definition  of  the  object  is  a  fair  description  of 
the  book.    The  work  is  a  useful  one,  giving  in  a 


short  space  the  theories,  facts  and  treatments,  and 
going  more  fully  into  their  later  developments. 
On  treatment  the  writer  is  particularly  strong, 
steering  clear  of  generalities,  and  seldom  omit- 
ting, what  text-books  usually  do,  the  unimportant 
items  which  are  all  important  to  the  general  prac- 
titioner.— The  Manchester  Medical  Chronicle,  Oct., 
1886. 


MOMMIS,  MBNRY,  M.  B,,  F,  B.  C.  S,, 

Surgeon  to  and  Lecturer  on  Surgery  at  Middlesex  Hospital,  London. 

Surgical  Diseases  of  the  Kidney.     In  one  12mo.  volume  of  554  pages,  with  40 
woodcuts,  and  6  colored  plates.  Limp  cloth,  |2.25.     See  Series  of  Clinical  Manuals,  page  4. 


In  this  manual  we  have  a  distinct  addition  to 
surgical  literature,  which  gives  information  not 
elsewhere  to  be  met  with  in  a  single  work.  Such 
a  book  was  distinctly  required,  and  Mr.  Morris 
has  very  diligently  and  ably  performed  the  task 


he  took  in  hand.  It  is  a  full  and  trustworthy 
book  of  reference,  both  for  students  and  prac- 
titioners in  search  of  guidance.  The  illustrations 
in  the  text  and  the  chromo-lithographs  are  beau- 
tifully executed. — The  London  Laneet,Feh.  26, 1886. 


LUCAS,  CLBMENT,  M.  B.,  B.  S.,  I,  B,  C,  S., 

Senior  Assistant  Surgeon  to  Ouifs  Hospital,  London. 
Diseases   of  the   Urethra.      In  one   12mo.  volume.     Preparing.     See  S&ries 
of  Clinical  Manuals,  page  4. 

TSOMBSOJV,  SIB  SBNBY, 

Surgeon  and  Professor  of  Clinical  Surgery  to  University  College  Hospital,  London. 

Lectures  on  Diseases  of  the  Urinary  Organs.  Second  American  from  the 
third  English  edition.     In  one  8vo.  volume  of  203  pp.,  with  25  illustrations.     Cloth,  $2.25. 

By  the  Same  Author. 
On  the  Pathology  and  Treatment  of  Stricture  of  the  Urethra  and 
Urinary  Fistulse.     From  the  third  English  edition.     In  one  octavo  volume  of  359 
pages,  with  47  cuts  and  3  plates.    Cloth,  $3.50. 

THB  AMBBICAJSr  SYSTEM  OF  BENTISTBY, 

In  Treatises  by  Various  Authors.  Edited  by  Wilbur  F.  Litch,  M.  D,, 
D.  D.  S.,  Professor  of  Prosthetic  Dentistry,  Materia  Medica  and  Therapeutics  in  the 
Pennsylvania  College  of  Dental  Surgery.  In  three  very  handsome  octavo  volumes  of 
about  1000  pages  each,  richly  illustrated.  Per  volume,  cloth,  |6 ;  leather,  $7 ;  half 
Morocco,  gilt  top,  $8.  Volume  I.,  containing  1015  pages,  with  6  plates  and  €37  woodcuts, 
just  ready.      For  sale  by  subscription  only. 

As  an  eneyclopsedia  of  Dentistry  it  has  no  su- 
perior. It  should  form  a  part  of  every  dentist's 
library,  as  the  information  it  contains  is  of  the 
greatest  value  to  all  engaged  in  the  practice  of 
dentistry. — American  Journal  of  Dental  Science, 
September,  1886. 

A  grand  system,  big  enough  and  good  enough 
and  handsome  enough  for  a  monument  (which 


doubtless  it  is),  to  mark  an  epoch  in  the  history  of 
dentistry.  Dentists  will  be  satisfied  with  it  and 
proud  of  it — they  must.  It  is  sure  to  be  precisely 
what  the  student  needs  to  put  him  and  keep  him 
in  the  ri^ht  track,  while  the  profession  at  large 
will  receive  incalculable  benefit  from  it. — Odonto- 
graphic  Journal,  Jan.  1887. 


COLEMAJf,  A,,  L,  B.  C,  JP.,  F.  B.  C,  S.,  Exam.  i.  D,  S., 

Senior  Dent.  Surg,  and  Lect.  on  Dent.  Surg,  at  St.  Bartholomew's  Hasp,  and  the  Dent.  Hosp.,  London. 

A  Manual  of  Dental  Surgery  and  Pathology.  Thoroughly  revised  and 
adapted  to  the  use  of  American  Students,  by  Thomas  C.  SteI/Lwagen,  M.  A.,  M.  D., 
D.  D.  S.,  Prof,  of  Physiology  at  the  Philadelphia  Dental  College.  In  one  handsome  octavo 
volume  of  412  pages,  with  331  illustrations.     Cloth,  $3.25. 

ESMABCS,  Dr.  FBIEDBICBT, 

Professor  of  Surgery  at  the  University  of  Kiel,  etc. 

Early  Aid  in  injuries  and  Accidents.  Five  Ambulance  Lectures.  Trans- 
lated by  H.  R.  H.  Pkincess  Christian.  In  one  handsome  small  12mo.  volume  of  lO^ 
pages,  with  24  illustrations.     Cloth,  75  cents. 

BASHAM    on    renal    diseases  :   A   Clinical    I    one  12mo.  vol.  of  304  pages,  with  21  lUustrationB, 
Guide  to  their  Diagnosis  and   Treatment.    In    |    Cloth,  $2.00. 


Lea  Brothers  &  Co.'s  Publications — Venereal,  Impotence. 


25 


BJJMSTEAn,  F.  J., 

M.  JD.,  LL.  D., 

Late  Professor  of  Venereal  Diseases 
at  the  College  of  Physicians  and 
Surgeons,  New  York,  etc. 


and  TAYJLOIt,  JR.  W., 

A.  M.,  M.  JD., 

Surgeon  to  Charity  Hospital,  New  York,  Prof,  of 
Venereal  and  Skin  Diseases  in  the  University  of 
Vermont,  Pres.  of  the  Am.  Dermatological  Ass'n. 


The  Pathology  and  Treatment  of  Venereal  Diseases.  Including  the 
results  of  recent  investigations  upon  the  subject.  Fifth  edition,  revised  and  largely  re- 
written, by  Dr.  Taylor.  In  one  large  and  handsome  octavo  volume  of  898  pages  with 
139  illustrations,  and  thirteen  chromo-lithographic  figures.  Cloth,  $4.75 ;  leather,  $5.75 ; 
very  handsome  half  Eussia,  $6.25. 


It  is  a  splendid  record  of  honest  labor,  wide 
research,  just  comparison,  careful  scrutiny  and 
original  experience,  which  will  always  be  held  as 
a  high  credit  to  American  medical  literature.  This 
is  not  only  the  best  work  in  the  English  language 
upon  the  subjects  of  which  it  treats,  but  also  one 
wnich  has  no  equa.  in  other  tongues  for  its  clear, 
comprehensive  and  practical  handling  of  its 
themes. — American  Journal  of  the  Medical  Sciences, 
Jan,  1884. 

It  is  certainly  the  best  single  treatise  on  vene- 
real in  our  own,  and  probably  the  best  in  any  lan- 
guage.— Boston  Medical  and  Surgical  Journal,  April 
3, 1884. 


The  character  of  this  standard  work  is  so  well 
known  that  it  would  be  superfluous  here  to  pass  in 
review  its  general  or  special  points  of  excellence. 
The  verdict  of  the  profession  has  been  passed;  it 
has  been  accepted  as  the  most  thorough  and  com- 
plete exposition  of  th*  pathology  and  treatment  of 
venereal  diseases  in  the  language.  Admirable  as  a 
model  of  clear  description,  an  exponent  of  sound 
pathological  doctrine,  and  a  guide  for  rational  and 
successful  treatment,  it  is  an  ornament  to  the  medi- 
cal literature  of  this  country.  The  additions  made 
to  the  present  edition  are  eminently  judicious, 
from  the  standpoint  of  practical  utility. — Journal  of 
Cutaneous  and  Venereal  Diseases,  Jan.  1884. 


COMJSl^L,  v., 

Professor  to  the  Faculty  of  Medicine  of  Paris,  and  Physician  to  the  Lour  cine  Hospital. 

Syphilis,  its  Morbid  Anatomy,  Diagnosis  and  Treatment.  Specially 
revised  by  the  Author,  and  translated  with  notes  and  additions  by  J.  Heney  C.  Simes, 
M.  D.,  Demonstrator  of  Pathological  Histology  in  the  University  of  Pennsylvania,  and 
J.  WrLLiAM  White,  M.  D.,  Lecturer  on  Venereal  Diseases  and  Demonstrator  of  Surgery 
in  the  University  of  Pennsylvania.  In  one  handsome  octavo  volume  of  461  pages,  with 
84  very  beautiful  illustrations.     Cloth,  $3.75. 

The  anatomical  and  histological  characters  of  the  '  the  whole  volume  is  the  clinical  experience  of  the 
hard  and  soft  sore  are  admirably  described.  The  '  author  or  the  wide  acquaintance  of  the  translators 
multiform  cutaneous  manifestations  of  the  disease  i  with  medical  literature  more  evident.  The  anat- 
are  dealt  with  histologically  in  a  masterly  way,  as  j  omy,  the  histology,  the  pathology  and  the  clinical 
we  should  indeed  expect  them  to  be,  and  the  j  features  of  syphilis  are  represented  in  this  work  in 
accompanying  illustrations  are  executed  carefully  |  their  best,  most  practical  and  most  instructive 
and  well.  The  various  nervous  lesions  which  are  ,  form,  and  no  one  will  rise  from  its  perusal  without 
the  recognized  outcome  of  the  syphilitic  dj^scrasia  ;  the  feeling  that  his  grasp  of  the  wide  and  impor- 
are  treated  with  care  and  consideration.  Syphilitic  .  tant  subject  on  which  it  treats  is  a  stronger  and 
epilepsy,  paralysis,  cerebral  syphilis  and  locomotor  !  surer  one. — The  London  Practitioner,  Jan.  1882. 
ataxia  are  subjects  full  of  interest;  and  nowhere  in  I 


JETUTCSINSOW,  JOJS^ATMAN,  F.  B.  S.,  F.  B.  C.  S., 

Consulting  Surgeon  to  the  London  Hospital. 
Syphilis.     In  one  12mo.  volume.     Shortly.     See  Series  of  Clinical  Manuals,  page  4. 

GMOSS,  SAMUFL  W,,  A,  M.,  M.  D., 

Professor  of  the  Principles  of  Surgery  and  of  Clinical  Surgery  in  the  Jefferson  Medical  College  of  Phila. 

A  Practical  Treatise  on  Impotence,  Sterility,  and  Allied  i)isorders 
of  the  Male  Sexual  Organs.  Third  edition,  thoroughly  revised.  In  one  very  hand- 
some octavo  volume  of  about  175  pages,  with  about  20  illustrations.     In  press. 

A  notice  of  the  previous  edition  is  appended. 
_  The  author  of  this  monograph  is  a  man  of  posi-  !  book  shows  that  he  has  not  neglected  to  compare 
tive  convictions  and  vigorous  style.  This  is  iusti-  ;  his  own  views  with  those  of  other  authors.  The 
fied  by  his  experience  and  by  his  study,  which  has  '  result  is  a  work  which  can  be  safely  recommended 
gone  hand  in  hand  with  his  experience.  In  regard  to  both  physicians  and  surgeons  as  a  guide  in  the 
to  the  various  organic  and  functional  disorders  of  treatment  of  the  disturbances  it  refers  to.  It  is 
the  male  generative  apparatus,  he  has  had  ex-  ,  the  best  treatise  on  the  subject  with  which  we  are 
ceptional  opportunities  for  observation,  and  his  !  acquainted.— TAe  Medical  Neios,  Sept.  1, 1883. 

GROSS,  S.  D.,  M.  !>.,  ii.  J>.,  D.  C,  X.,  etc. 

A  Practical  Treatise  on  the  Diseases,  Injuries  and  Malformations 
of  the  Urinary  Bladder,  the  Prostate  Gland  and  the  Urethra.  Third 
edition,  thoroughly  revised  by  SAMXXEii  W.  Gnoss,  M.  D.  In  one  octavo  volume  of  574 
pages,  with  170  illustrations.     Cloth,  $4.50. 

CTJLLFMIEIt,  A,,  <&  BUMSTFAD,  F.  J.,  M.I>.,  LL.D., 

Surgeon  to  the  Hdpital  du  Midi.         Late  Professor  of  Venereal  Diseases  in  the  College  of  Physicians 

and  Surgeons,  New  York. 

An  Atlas  of  Venereal  Diseases.  Translated  and  edited  by  Freeman  J.  Btjm- 
STEAD,  M.  D.  In  one  imperial  4to.  volume  of  328  pages,  double-columns,  with  26  plates, 
containing  about  150  figures,  beautifully  colored,  many  of  them  the  size  of  life.  Strongly 
bound  in  cloth,  $17.00.    A  specimen  of  the  plates  and  text  sent  by  mail,  on  receipt  of  25  cts. 


HILL  ON  SYPHILIS  AND  LOCAL  CONTAGIOUS 

DISORDERS.  In  one  8vo  vol.  of  479  p.  Cloth,  83.25. 

LEE'S  LECTURES  ON  SYPHILIS  AND  SOME 


FORMS  OF  LOCAL  DISEASE  AFFECTING 
PRINCIPALLY  THE  ORGANS  OF  GENERA- 
TION.   In  one  8vo.  vol.  of  246  pages.    Cloth,  S2.25. 


26  Lea  Brothers  &  Co.'s  Publications — Diseases  of  Skin. 

STDJE,  J,  WBVIWS,  A.  M.,  M.  !>., 

Professor  of  Dermatology  and  Venereal  Diseases  in  Bush  Medical  College,  Chicago. 

A  Practical  Treatise  on  Diseases  of  the  Skin.  For  the  use  of  Students  and 
Practitioners.  In  one  handsome  octavo  volume  of  570  pages,  with  66  beautiful  and  elab- 
orate illustrations.     Cloth,  54.25 ;  leather,  §5.25. 


The  author  has  given  the  student  and  practi- 
tioner a  work  admirably  adapted  to  the  wants  of 
each.  We  can  heartily  commend  the  book  as  a 
valuable  addition  to  our  literature  and  a  reliable 
guide  to  students  and  practitioners  in  their  studies 


Professor  Hyde  has  long  been  known  as  one  of 
the  most  intelligent  and  enthusiastic  representa- 
tives of  dermatology  in  the  west.  His  numerous 
contributions  to  t^e  literature  of  this  specialty 
have  gained  for  him  a  favorable  recognition  as  a 


and  practice. — Am.  Journ.  of  Med.  Set.,  July,  18S3.  careful,  conscientious  and  original  observer.  The 
The  aim  of  the  author  has  been  to  present  to  his  remarkable  advances  made  in  our  knowledge  of 
readers  a  work  not  only  expounding  the  most  diseases  of  the  skin,  especially  from  the  stand- 
modern  conceptions  of  his  subiect,  but  presenting  point  of  pathological  liistology  and  improved 
what  is  of  standard  value.  He  has  more  especially  methods  of  treatment,  necessitate  a  revision  of 
devoted  its  pages  to  the  treatment  of  disease,  and  the  older  text-books  at  short  intervals  in  order  to 
by  his  detailed  descriptions  of  therapeutic  meas-  bring  them  up  to  the  standard  demanded  by  the 
ures  has  adapted  them  to  the  needs  of  the  physi-  march  of  science.  This  last  contribution  of  Dr. 
cian  in  active  practice.  In  dealing  with  these  Hyde  is  an  effort  in  this  direction.  He  has  at- 
questions  the  author  leaves  nothing  to  the  pre-  tempted,  as  he  informs  us,  the  task  of  presenting 
sumed  knowledge  of  the  reader,  but  enters  thor-  '  in  a  condensed  form  the  results  of  the  latest  ob- 
oughly  into  the  most  minute  description,  so  that  servation  and  experience.  A  careful  examination 
one  is  not  only  told  what  should  be  done  under  !  of  the  work  convinces  us  that  he  has  accomplished 
given  conditions  but  how  to  do  it  as  well.  It  is  his  task  with  painstaking  fidelity  and  with  acred- 
therefore  in  the  best  sense  "a  practical  treatise."  |  itable  result. — Journal  of  Cutaneous  and  Venereal 
That  it  is  comprehensive,  a  glance  at  the  index  I  Diseases,  June,  1883. 
will  show. — Mbryland  Medical  Journal,  July  7, 1883.  | 


AJ^DEMSOW,  T.  M'CALL,  M,  D,, 

Professor  of  Clinical  Medicine  in  the  University  of  Glasgow. 

A  Text-Book  of  Skin  Diseases.  With  Special  Reference  to  Diag- 
nosis and  Treatment.  In  one  octavo  volume,  with  two  chromo-lithographs,  a  steel 
plate  and  numerous  illustrations.     Shortly. 

FOX,  T.,  M.n,,  F,It,  C.  jP.,  and  FOX,  T,  C,  B,A,,  M,It.  C.S,, 

Physician  to  the  Department  for  Skin  Diseases,  Physician  for  Diseases  of  the  Skin  to  the 

University  College  Hospital,  London.  Westminster  Hospital,  London. 

An  Epitome  of  Skin  Diseases.  With  Pormulse.  For  Students  and  Prac- 
titioners. Third  edition,  revised  and  enlarged.  In  one  very  handsome  12mo.  volume 
of  238  pages.    Cloth,  $1.25. 

The  third  edition  of  this  convenient  handbook  '  manual  to  lie  upon  the  table  for  instant  reference, 
calls  for  notice  owing  to  the  revision  and  expansion  ;  Its  alphabetical  arrangement  is  suited  to  this  use, 
which  it  has  undergone.  The  arrangement  of  skin  j  for  all  one  has  to  know  is  the  name  of  the  disease, 
diseases  in  alphabetical  order,  which  is  the  method  -  and  here  are  its  description  and  the  appropriate 
of  classification  adopted  in  this  work,  becomes  a  ;  treatment  at  hand  and  ready  for  instant  applica- 
positive  advantage  to  the  student.  The  book  is  i  tion.  The  present  edition  has  been  very  carefully 
one  which  we  can  strongly  recommend,  not  only  !  revised  and  a  number  of  new  diseases  are  de- 
to  students  but  also  to  practitioners  who  require  a  '  scribed,  while  most  of  the  recent  additions  to 
compendious  summary  of  the  present  state  of  !  dermal  therapeutics  find  mention,  and  the  formu- 
dermatology. — British  Medical  Journal,  July  2, 1883.  i  lary  at  the  end  of  the  book  has  been  considerably 

We  cordially  recommend  Fox's  ^pitome'to  those  j  augmented. — The  Medical  News,  December,  1883. 
whose  time  is  limited  and  who  wish    a  handy  j 


MORMIS,  3IALCOLM,  F.  B.  C.  S., 

Joint  Lecturer  on  Dermatology  at  St.  Mary''s  Hospital  Medical  School,  London. 
Skin  Diseases ;  Including  their  Definitions,  Symptoms,  Diagnosis,  Prognosis,  Mor- 
bid Anatomy  and  Treatment.     A  Manual  for  Students  and  Practitioners.     In  one  12mo. 
volume  of  316  pages,  with  illustrations.     Cloth,  $1.75. 

To  physicians  who  would  like  to  know  something  for  clearness  of  expression  and  methodical  ar- 
about  skin  diseases,  so  that  when  a  patient  pre-  rangement  is  better  adapted  to  promote  a  rational 
sents  himself  for  relief  they  can  make  a  correct  ;  conception  of  dermatology — a  branch  confessedly 
diagnosis  and  prescribe  a  rational  treatment,  we  :  difficult  and  perplexing  to  the  beginner. — St.  Louis 
unhesitatingly  recommend  this  little  book  of  Dr.  :  Courier  of  Medicine,  April,  1880. 
Morris.  The  afiFections  of  the  skin  are  described  j  The  writer  has  certainly  given  in  a  small  compass 
in  a  terse,  lucid  manner,  and  their  several  charac-  ,  a  large  amount  of  well-compiled  information,  and 
teristics  so  plamly  set  forth  that  diagnosis  will  be  :  his  little  book  compares  favorably  with  any  other 
easy.  /I  he  treatment  m  each  case  is  such  as  the  |  which  has  emanated  from  England,  while  in  many 
experience  of  the  most  eminent  dermatologists  ad-  i  points  he  has  emancipated  himself  from  the  st-ah- 
•viaes.— Cincinnati  Medical  ]\ews,  April,  1880.  !  tornly  adhered  to  errors  of  others  of  his  country- 

This  is  emphatically  a  learner's  book ;  for  we  men.  There  is  certainly  excellent  material  in  the 
can  safely  say,  that  in  the  whole  range  of  medical  book  which  will  well  repay  perusal. — Boston  Med. 
literature  there  is  no  book  of  a  like  scope  which    and  Surg.  Journ.,  March,  1880. 

WILSOJV,  FMASMUS,  F.  M.  S. 

The  Student's  Book  of  Cutaneous  Medicine  and  Diseases  of  the  Skin. 
In  one  handsome  small  octavo  volume  of  535  pages.     Cloth,  $3.50. 

HILLIER,  TJBCOMAS,  31.  D., 

Physician  to  the  Skin  Department  of  University  College,  London. 
Handbook  of  Skin  Diseases;  for  Students  and  Practitioners.     Second  Ameri- 
can edition.     In  one  12mo.  volume  of  353  pages,  with  plates.     Cloth,  $2.25. 


Lea  Brothers  &  Co.'s  Publications — Dis.  of  Women. 


27 


AJ^  AMBMICAJS^  SYSTEM  OF  GTJ^^COLOGT, 

A  System  of  Gynseeclogy,  in  Treatises  by  Various  Authors.  Edited 
by  Matthew  D.  Mann,  M.  D.,  Professor  of  Obstetrics  and  Gynaecology  in  the  Uni- 
versity of  Buffalo,  ISl".  Y.  In  two  handsome  octavo  volumes,  richly  illustrated.  In  active 
preparation. 

LIST  OF  CONTRIBUTORS. 


WILLIAM  H.  BAKER,  M.  D., 
FORDYCE  BARKER,  M.  D., 
ROBERT  BATTEY,  M.  D., 
SAMUEL  C.  BUSEY,  M.  D., 
HENRY  C.  COE,  M.  D., 
E.  C.  DUDLEY,  M.  D., 
GEORGE  J.  ENGELMANN,  M.  D., 
HENRY  F.  GARRIGUES,  M.  D., 
WILLIAM  GOODELL,  M.  D., 
EGBERT  H.  GRANDIN,  M.  D., 
SAMUEL  W.  GROSS,  M.  D., 
JAMES  B.  HUNTER,  M.  D., 
A.  REEVES  JACKSON,  M.  D., 
EDWARD  W.  JENKS,  M.  D., 


WILLIAM  T.  LUSK,  M.  D., 

MATTHEW  D.  MANN,  M.  D., 

ROBERT  B.  MAURY,  M.  D., 

PAUL  F.  MUNDE,  M.  D., 

C.  D.  PALMER,  M.  D., 

WILLIAM  M.  POLK,  M.  D., 

THADDEUS  A.  REAMY,  M.  D., 

A.  D.  ROCKWELL,  M.  D., 

ALEX.  J.  C.  SKENE,  M.  D., 

R.  STANSBURY  SUTTON,  A.  M.,  M.  D. 

T.  GAILLARD  THOMAS,  M.  D., 

ELY  VAN  DE  WARKER,  M.  D., 

W.  GILL  WYLIE,  M.  D. 


TSOMAS,  T.  GAILLARD,  M,  2>., 

Professor  of  Diseases  of  Women  in  the  College  of  PhysU:iam  and  Surgeons,  N.  Y. 

A  Practical  Treatise  on  the  Diseases  of  Women.  Fifth  edition,  thoroughly 
revised  and  rewritten.  In  one  large  and  handsome  octavo  volume  of  810  pages,  with  266 
illustrations.     Cloth,  $5.00 ;  leather,  $6.00 ;  very  handsome  half  Kussia,  raised  bands,  $6.50. 

The  words  which  follow  "  fifth  edition"  are  in  vious  one.  As  a  book  of  reference  for  the  busy 
this  case  no  mere  formal  announcement.  The  practitioner  it  is  unequalled.— Boston  Medical  and 
alterations  and  additions  which  have  been  made  are    Surgical  Journal,  April  7, 1S80. 

both  numerous  and  important.  The  attraction!  It  has  been  enlarged  and  carefully  revised.  It  is 
and  the  permanent  character  of  this  book  lie  in  a  condensed  encyclopaedia  of  gynecological  medi- 
the  clearness  and  truth  of  the  clinical  descriptions  cine.  The  style  of  arrangement,  the  masterly 
of  diseases;  the  fertility  of  the  author  in  thera-  manner  in  which  each  subject  is  treated,  and  the 
peutic  resources  and  the  fulness  with  which  the  honest  convictions  derived  from  probably  the 
details  of  treatment  are  described;  the  definite  largest  clinical  experience  in  that  specialty  of  any 
character  of  the  teaching;  and  last,  but  not  least,  in  this  country,  all  serve  to  commend  it  in  the 
the  evident  candor  which  pervades  it.  We  would  highest  terms  to  the  practitioner. — Nashville  Jour. 
also  particularize  the  fulness  with  which  the  his-    of  Med.  and  Surg.,  Jan.  1881. 

tory  of  the  subject  is  gone  into,  which  makes  the  That  the  previous  editions  of  the  treatise  of  Dr. 
book  additionally  interesting  and  gives  it  value  as  Thomas  were  thought  worthy  of  translation  into 
a  work  of  reference. — London  Medical  Times  and  German,  French,  Italian  and  Spanish,  is  enough 
Gazette,  July  30, 1881.  to  give  it  the  stamp  of  genuine  merit.    At  home  it 

The  determination  of  the  author  to  keep  his  has  made  its  way  into  the  library  of  every  obstet- 
book  foremost  in  the  rank  of  works  on  gynaecology  rieian  and  gynaeologist  as  a  safe  guide  to  practice, 
is  most  gratifying.  Recognizing  the  fact  that  this  No  small  number  of  additions  have  been  made  to 
can  only  be  accomplished  by  frequent  and  thor-  the  present  edition  to  make  it  correspond  to  re- 
ough  revision,  he  has  spared  no  pains  to  make  the  cent  improvements  in  treatment. — Pacific  Medical 
present  edition  more  desirable  even  than  the  pre-  I  arid  Surgical  Journal,  Jan.  1881. 


EDIS,  ATiTTTUn  W,,  M.  D.,  Land.,  F.B.  C.F.,  M.M,  C.S,, 

Assist.  Obstetric  Physician  to  Middlesex  Hospital,  late  Physician  to  British  Lying-in  Hospital. 
The  Diseases  of  Women.     Including  their  Pathology,  Causation,  Symptoms, 
Diagnosis  and  Treatment.     A  Manual  for  Students  and  Practitioners.     In  one  handsome 
octavo  volume  of  576  pages,  with  148  illustrations.     Cloth,  $3.00 ;  leather,  $4.00. 

It  is  a  pleasure  to  read  a  book  so  thoroughly  i  The  greatest  pains  have  been  taken  with  the 
good  as  this  one.  The  special  qualities  which  are  sections  relating  to  treatment.  A  liberal  selection 
conspicuous  are  thoroughness  in  covering  the  of  remedies  is  given  for  each  morbid  condition, 
whole  ground,  clearness  of  description  and  con-  the  strength,  mode  of  application  and  other  details 
ciseness  of  statement.  Another  marked  feature  of  being  fully  explained.  The  descriptions  of  gynse- 
the  book  is  the  attention  paid  to  the  details  of  cological  manipulations  and  operations  are  full, 
many  minor  surgical  operations  and  procedures,  clear  and  practical.  Much  care  has  also  been  be- 
as,  for  instance,  the  use  of  tents,  application  of  stowed  on  the  parts  of  the  book  which  deal  with 
leeches,  and  use  of  hot  water  injections.  These  ■.  diagnosis — we  note  especially  the  pages  dealing 
are  among  the  more  common  methods  of  treat-  '  with  the  difl'erentiation,  one  from  another,  of  the 
ment,  and  yet  very  little  is  said  about  them  in  |  different  kinds  of  abdominal  tumors.  The  prac- 
many  of  the  text-books.  The  book  is  one  to  be  titioner  will  therefore  find  in  this  book  the  kind 
warmly  recommended  especially  to  students  and  !  of  knowledge  he  most  needs  in  his  daily  work,  and 
general  practitioners,  who  need  a  concise  Vjut  com-  :  he  will  be  pleased  with  the  clearness  and  fulness 
pleteresume  of  the  whole  subject.  Specialists,  too,  I  of  the  information  there  given. —  The  Practitioner, 
will  find  many  useful  hints  in  its  pages. — Boston  i  Feb.  1882. 
Med.  and  Surg.  Journ.,  March  2, 1882.  ' 


BABJSTFS,  ItOBEMT,  M.  !>.,  F.  M.  C.  JP., 

Obstetric  Physician  to  St.  Th.amns''  Hospital,  London,  etc.  ^^ 

A  Clinical  Exposition  of  the  Medical  and  Surgical  Diseases  of  Women. 

In  one  handsome  octavo  volume,  with  numerous  illustrations.     New  edition.    Preparing. 


WEST,  CMAMLES,  M.  B. 

Lectures  on  the  Diseases  of  Women.     Third  American  from  the  third  Lon- 
don edition.     In  one  octavo  volume  of  543  pages.     Cloth,  $3.75 ;  leather,  $4.75. 


28 


Lea  Brothers  &  Co.'s  Publications — Dis.  of  Women,  Midwfy. 


BMMBT,  TMOMAS  ADDIS,  M,  JD.,  LL,  D,, 

Surgeon  to  the  Woman's  Hospital,  New  York,  etc. 

The  Principles  and  Practice  of  Gynaecology ;  For  the  use  of  Students  and 
Practitioners  of  Medicine.  New  (third)  edition,  thoroughly  revised.  In  one  large  and  very 
handsome  octavo  volume  of  880  pages,  with  150  illustrations.  Cloth,  $5 ;  leather,  $6 ; 
very  handsome  half  Russia,  raised  bands,  $6.50. 

once  a  credit  to  its  author  and  to  American  med- 
ical literature.  We  repeat  that  it  is  a  book  to  be 


We  are  in  doubt  whether  to  congratulate  the 
author  more  than  the  profession  upon  the  appear- 
ance of  the  third  edition  of  this  well-known  work. 
Embodying,  as  it  does,  the  life-long  experience  of 
one  who  has  conspicuously  distinguished  himself 
as  a  bold  and  successful  operator,  and  who  has 
devoted  so  much  attention  to  the  specialty,  we 
feel  sure  the  profession  will  not  fail  to  appreciate 
the  privilege  thus  offered  them  of  perusing  the 
views  and  practice  of  the  author.  His  earnestness 
of  purpose  and  conscientiousness  are  manifest. 
He  gives  not  only  his  individual  experience  but 
endeavors  to  represent  the  actual  state  of  gynas- 
cological  science  and  art. — British  Medical  Jour- 
nal, May  16,  1885. 

No  jot  or  tittle  of  the  high  praise  bestowed  upon 
the  first  edition  is  abated.  It  is  still  a  book  of 
marked  personality,  one  based  upon  large  clinical 
experience,  containing  large  and  valuable  ad- 
ditions to  our  knowledge,  evidently  written  not 
only  with  honesty  of  purpose,  but  with  a  conscien- 
tious sense  of  responsibility,  and  a  book  that  is  at 


studied,  and  one  that  is  indispensable  to  every 
practitioner  giving  any  attention  to  gynaecology. — 
American  Journal  of  the  Medical  Sciences,  April,  1885. 
The  time  has  passed  when  Emmet's  Oyncecology 
was  to  be  regarded  as  a  book  for  a  single  country 
or  for  a  single  generation.  It  has  always  been  his 
aim  to  popularize  gynsecology,  to  bring  it  within 
easy  reach  of  the  general  practitioner.  The  orig- 
inality of  the  ideas,  asidd  from  the  perfect  con- 
fidence which  we  feel  in  the  author's  statements, 
compels  our  admiration  and  respect.  We  may 
well  take  an  honest  pride  in  Dr.  Emmet's  work 
and  feel  that  his  book  can  hold  its  own  against  the 
criticism  of  two  continents.  It  represents  all  that 
is  most  earnest  and  most  thoughtful  in  American 
gynasoology.  Emmet's  work  will  continue  to 
reflect  the  individuality,  the  sterling  integrity  and 
the  kindly  heart  of  its  honored  author  long  after 
smaller  books  have  been  forgotten. — American 
Journal  of  Obstetrics,  May,  1885. 


DUJSrCAJSr,  J.  MATTSEWS,  M.D.,  LL,  D.,  I,  B.  S.  B.,  etc. 

Clinical  Lectures  on  the  Diseases  of  Women;  Delivered  in  Saint  Bar- 
tholomew's Hospital.     In  one  handsome  octavo  volume  of  175  pages.     Cloth,  $1.50. 


They  are  in  every  way  worthy  of  their  author  ; 
indeed,  we  look  upon  them  as  among  the  most 
valuable  of  his  contributions.  They  are  all  upon 
matters  of  great  interest  to  the  general  practitioner. 
Some  of  them  deal  with  subjects  that  are  not,  as  a 


rule,  adequately  handled  in  the  text-books;  others 
of  them,  while  bearing  upon  topics  that  are  usually 
treated  of  at  length  in  such  works,  3'et  bear  such  a 
stamp  of  individuality  that  they  deserve  to  be 
widely  read.— iV^.  Y.  Medical  Journal,  March,  1880. 


MAY,    CSAMLBS  S,,  M.  D. 

Late  House  Surgeon  to  Mount  Sinai  Hospital,  New  York. 

A  Manual  of  the  Diseases  of  Women.  Being  a  concise  and  systematic  expo- 
sition of  the  theory  and  practice  of  gynsecologv.  In  one  12mo.  volume  of  342  pages; 
Cloth,  11.75. 


Medical  students  will  find  this  work  adapted  to 
their  wants.  Also  practitioners  of  medicine  will 
find  it  exceedingly  convenient  to  consult  for  the 
purpose  of  refreshing  their  minds  upon  the  lead- 
ing points  of  a  gynsecologica!  subject.  By  syste- 
matic condensation,  the  omission  of  disputed  ques- 


tions, and  the  presentation  only  of  accepted  views, 
it  constitutes  a  very  satisfactory  exposition  of  the 
leading  principles  of  gynaecology  as  they  are  UHf 
derstood  at  the  present  time. — Cincinnati  Medical 

News,  Nov.  1885. 


HODGB,  BUGHL.,  M.  D., 

Emeritus  Professor  of  Obstetrics,  etc.,  in  the  University  of  Pennsylvania. 

On  Diseases  Peculiar  to  Women;  Including  Displacements  of  the  Uterus. 
Second  edition,  revised  and  enlarged.  In  one  beautifully  printed  octavo  volume  of  519 
pages,  with  original  illustrations.     Cloth,  $4.50. 

By  the  Same  Author. 

The  Principles  and  Practice  of  Obstetrics.  Illustrated  with  large  litho- 
graphic plates  containing  159  figures  from  original  photographs,  and  with  numerous  wood- 
cuts. In  one  large  quarto  volume  of  542  double-columned  pages.  Strongly  bound  in 
cloth,  $14.00.  Specimens  of  the  plates  and  letter-press  will  be  forwarded  to  any  address, 
free  by  mail,  on  receipt  of  six  cents  in  postage  stamps. 

MAMSBOTMAM,  FMAH^CIS  H,,  M,  J). 

The  Principles  and  Practice  of  Obstetric  Medicine  and  Surgery; 

In  reference  to  the  Process  of  Parturition.  A  new  and  enlarged  edition,  thoroughly  revised 
by  the  Author.  With  additions  by  W.  V.  Keating,  M.  D.,  Professor  of  Obstetrics,  etc., 
in  the  Jefferson  Medical  College  of  Philadelphia.  In  one  large  and  handsome  imperial 
octavo  volume  of  640  pages,  with  64  full-page  plates  and  43  woodcuts  in  the  text,  contain- 
ing in  all  nearly  200  beautiful  figures.     Strongly  bound  in  leather,  with  raised  bands,  $7. 

WINCKBL,  F. 

A  Complete  Treatise  on  the  Pathology  and  Treatment  of  Childbed, 

For  Students  and  Practitioners.  Translated,  with  the  consent  of  the  Author,  from  the 
second  German  edition,  by  J,  R.  Chadwick,  M.  D.     Octavo  484  pages.     Cloth,  $4.00. 


ASHWELL'S  PRACTICAL  TREATISE  ON  THE 
DISEASES  PECULIAR  TO  WOMEN.  Third 
American  from  the  third  and  revised  London 
edition.    In  one  8vo.  vol.,  pp.  520.    Cloth,  83.50. 

CHURCHILL  ON    THE   PUERPERAL  FEVER 


AND  OTHER  DISEASES  PECULIAR  TO  WO- 
MEN. In  one  8vo.  vol.  of  464  pages.  Cloth,  $2.50. 
MEIGS  ON  THE  NATURE,  SIGNS  AND  TREAT- 
MENT OF  CHILDBED  FEVER.  In  one  870. 
volume  of  346  pages.    Cloth,  $2.00. 


Lea  Brothers  &  Co.'s  Publications — Midwifery. 


29 


PAMVIN,  THEOPSILVS,  M.  2>.,  ii.  J>., 

Prof,  of  Obstetrics  and  the  Diseases  of  Women  and  Children  m  Jefferson  Med.  Coll.,  Philg,. 

The  Science  and  Art  of  Obstetrics.    In  one  handsome  8vo.  volume  of  697 
pages,  with  214  engravings  and  a  colored  plate.     Cloth,  $4.25  ;  leather,  |5.25.    Just  ready. 
"     "    ■  ■  "  This  treatise,  by  the  professor  of  the  branch  in 

the  Jefferson  Medical  College  of  Philadelphia,  has 
been  the  result  of  years  of  careful  study  directed 
to  the  presentation  of  the  suVJect  in  the  most 
complete  manner  consistent  with  the  limits  of  a 
manual  r f  itistruction.  Dr.  Parvin's  well-known 
literary  ability  gives  him  unusual  advantages  for 
precisely  such  an  undertaking,  and  he  is  to  be 
congratulated  on  the  success  with  which  he  has 
accomplished  ii.— Medical  and  Surgical  Reporter, 
January  29, 1887. 


The  author  has  had  the  experience  of  an  exten- 
sive obstetric  practice  of  upward  of  thirty -four 
years,  nearly  two-thirds  of  which  time  he  has  been 
a  medical  teacher,  and  consequently  he  has  embod- 
ied in  his  work  a  large  amount  of  valuable  infor- 
mation derived  from  personal  observation  and 
reflection.  The  student  and  physician,  therefore, 
who  study  this  work  can  feel  that  the  information 
contained  in  it  comes  from  the  author  as  his  own 
knowledge,  and  can  be  accepted  as  having  been 
verified  by  him. — Cincinnati  Medical  News,  Decem- 
ber, 1886. 


BARNES,  ItOBBMT,  M.  IP,,  and   FANCOVBT,  M.  D., 

Phys.  to  the  General  Lying-in  Bosp.,  Land.  Obstetric  Phys.  to  St.  Thomas'  Eosp.,  Land 

A  System  of  Obstetric  Medicine  and  Surgery,  Theoretical  and  Clin- 
ical. For  the  Student  and  the  Practitioner.  The  Section  on  Embryology  contributed  by 
Prof.  Milnes  Marshall.  In  one  handsome  octavo  volume  of  872  pages,  with  231  illus- 
trations.   Cloth,  %b ;  leather,  $6. 


This  system  will  be  eagerly  sought  for,  not  only 
on  account  of  its  intrinsic  merit,  but  also  because 
the  reputation  which  the  elder  Barnes,  in  particu- 
lar, has  secured,  carries  with  it  the  conviction  that 
any  book  emanating  from  him  is  necessarily  sound 
in  teaching  and  conservative  in  practice.    It  is  in 


ble  teacher  and  trusted  accoucheur,  should  embody 
within  a  single  treatise  the  system  which  he  has 
taught  and  in  practice  tested,  and  which  is  the  out- 
come of  a  lifetime  of  earnest  labor,  careful  obser- 
vation and  deep  study.  The  result  of  this  arrange- 
ment is  the  production  of  a  work  which  rises  above 


deed  eminently  fitting  that  a  man  who  has  done' so  criticism  and  which  in  no  respect  need  yield  the 
much  towards  systematizing  the  obstetric  art,  who  !  palm  to  any  obstetrical  treatise  hitherto  published. 
for  so  many  years  has  been  widely  known  as  a  capa-  i  — American  Journal  of  Obstetrics,  Feb.  1886. 

PLAYFAIM,  W.  S.,  M.  D.,  F.  M,  C,  F., 

Professor  of  Obstetric  Medicine  in  King's  College,  London,  etc. 

A  Treatise  on  the  Science  and  Practice  of  Midwifery.  New  (fourth) 
American,  from  the  fifth  English  edition.  Edited,  with  additions,  by  Eobekt  P.  Har- 
ris, M.  D.  In  one  handsome  octavo  volume  of  654  pages,  with  3  plates  and  201  engrav- 
ings.    Cloth,  |4 ;  leather,  $5 ;  half  Eussia,  |5.50. 

This  still  remains  a  favorite  in  America,  not 
only  because  the  author  is  recognized  as  a  safe 
guide  and  eminently  progressive  man,  but  also  as 
sparing  no  effort  to  make  each  successive  edition 
a  faithful  mirror  of  the  latest  and  best  practice. 
A  work  so  frequently  noticed  as  the  present 
requires  no  further  review.  We  believe  that  this 
edition  is  simply  the  forerunner  of  many  others, 
and  that  the  demand  will  keep  pace  with  the 


supply.— .4?nerican  Journal  of  Obstetrics,  Nov.,  1885. 
Since  its  first  publication,  only  eight  years  ago, 
it  has  rapidly  become  the  favorite  textrbook,  to 
the  practical  exclusion  of  all  others.  A  large 
measure  of  its  popularity  is  due  to  the  clear  and 
easy  style  in  which  it  is  written.  Few  text-books 
for  students  have  very  much  to  boast  of  in  this 
respect. — Medical  Record. 


KING,  A.  F.  A.,  M,  D,, 

Professor  of  Obstetrics  and  Diseases  of  Women  m  the  Medical  Department  of  the  Columbian  Univer- 
sity, Washington,  D.  C,  and  in  the  University  of  Vermont,  etc. 
A  Manual  of  Obstetrics.     New  (third)  edition.     In  one  very  handsome  12mo. 
volume  of  376  pages,  with  102  illustrations.     Cloth,  |2.25.     Just  ready. 


"■  This  is  the  best  of  the  recent  handbooks.  It  is 
"up  to  the  times."  Such  a  book  gives  full  direc- 
tions to  the  students,  while  it  is  a  memory  re- 
fresher to  the  practitioner  suddenly  called  upon  to 
do  something  a  little  out  of  the  ordinary  way. 
When  a  doctor  is  called  to  a  case  of  labor,  it  is  well 
for  him  to  take  abook  like  this  along  with  him,  and 
spend  the  half-hour  or  more  he  may  wish  to  "wait 


in  the  other  room"  in  looking  over  the  possible 
odds  and  ends  he  may  have  to  contend  with  in  a 
given  case.  Such  a  review  often  serves  all  the 
purposes  of  a  consultation  at  an  hour  of  the  night 
when  he  wants  a  bit  of  information,  and  yet  does 
not  care  to  rouse  his  brother  practitioner  from  his 
repose.  It  is  a  good  book. —  Virginia  Medical 
Monthly,  Nov.  1886. 


BABKFB,  FORDYCF,  AM.,  M,  !>.,  II.  D.  Edin., 

Clinical  Professor  of  Midwifery  and  the  Diseases  of  Women  in  the  Bellevue  Hospital  Medical  College, 
New  York,  Honorary  Fellow  of  the  Obstetrical  Societies  of  London  and  Edinburgh,  etc.,  etc. 

Obstetrical  and  Clinical  Essays.    In  one  handsome  12mo.  volume  of  about 
300  pages.     Preparing. 

BAMNES,  FANCOUBT,  M.  !>., 

Obstetric  Physician  to  St.  Thomas'  Hospital,  London. 

A  Manual  of  Midwifery  for  Midwives  and  Medical  Students.    In  one 
royal  12mo.  volume  of  197  pages,  with  50  illustrations.     Cloth,  $1.25. 

J?ABBY,  JOSN  S.,  M.  I>., 

Obstetrician  to  the  Philadelphia  Hospital,  Vice-President  of  the  Obstet.  Society  of  Philadelphia. 

Extra  -  Uterine  Pregnancy :  Its  Clinical  History,   Diagnosis,   Prognosis  and 
Treatment.     In  one  handsome  octavo  volume  of  272  pages.     Cloth,  $2.50. 


TANNER  ON  PREGNANCY.    Octavo,  490  pages,  4  colored  plates,  16  cuts.    Cloth,  S4.25. 


30 


Lea  Brothers  &  Co.'s  Publications — Midwfy.,  Dis.  CMldn. 


LEISSEMAJS^,  WILLIAM,  M.  D., 

Regtus  Professor  of  Midwifery  in  the  University  of  Glasgow,  etc. 

A  System  of  Midwifery,  Including  the  Diseases  of  Pregnancy  and  the 
Puerperal  State.  Third  American  edition,  revised  by  the  Author,  with  additions  by 
John  S.  Parry,  M.  D.,  Obstetrician  to  the  Philadelphia  Hospital,  etc.  In  one  large  and 
very  handsome  octavo  volume  of  740  pages,  with  205  illustrations.  Cloth,  $4.50 ;  leather, 
$5.50 ;  very  handsome  half  Russia,  raised  bands,  $6.00. 

The  author  is  broad  in  his  teachings,  and  dis- 
cusses briefly  the  comparative  anatomy  of  the  pel- 
vis and  the  mobility  of  the  pelvic  articulations. 
The    second    chapter   is    devoted    especially   to 


the  study  of  the  pelvis,  while  in  the  third  the 
female  organs  of  generation  are  introduced. 
The  structure  and  development  of  the  ovum  are 
admirably  described.  Then  follow  chapters  upon 
the  various  subjects  embraced  in  the  study  of  mid- 
wifery. The  descriptions  throughout  the  work  are 
plain  and  pleasing.    It  is  sufficient  to  state  that  in 


this,  the  last  edition  of  this  well-known  work,  every 
recent  advancement  in  this  field  has  been  brought 
forward. — Physician  mid  Surgeon,  Jan.  1880. 

To  the  American  student  the  work  before  us 
must  prove  admirably  adapted.  Complete  in  all  its 
parts,  essentially  modern  in  its  teachings,  and  with 
demonstrations  noted  for  clearness  and  precision, 
it  will  gain  in  favor  and  be  recognized  as  a  work 
of  standard  merit.  The  work  cannot  fail  to  be 
popular  and  is  cordially  recommended. — N.  O. 
Med.  and  Surg.  Journ.,  March.  1880. 


LANDIS,  MBWRY  G,,  A,  M.,  M,  2)., 

Professor  of  Obstetrics  and  the  Diseases  of  Women  in  Starling  Medical  College,  Columbus,  O. 

The  Management  of  Labor,  and  of  the   Lying-in  Period.     In  one 

handsome  12mo.  volume  of  334  pages,  with  28  illustrations.     Cloth,  $1.75.     Just  ready. 


This  is  a  book  we  can  heartily  recommend. 
The  author  goes  much  more  practically  into  the 
details  of  the  management  of  labor  than  most 
text^books,  and  is  so  readable  throughout  as  to 
tempt  any  one  who  should  happen  to  commence 
the  book  to  read  it  through.  The  author  pre- 
supposes a  theoretical  knowledge  of  obstetrics, 


and  has  consistently  excluded  from  this  little 
work  everything  that  is  not  of  practical  use  in  the 
lying-in  room.  We  think  that  if  it  is  as  widely 
read  as  it  deserves,  it  will  do  much  to  improve 
obstetric  practice  in  general. — New  Orleans  Medi- 
cal and  Surgical  Journal,  Mar.  1886. 


SMITH,  J,  LEWIS,  M,  D., 

Clinical  Professor  of  Diseases  of  Children  in  the  Bellevue  Hospital  Medical  College,  N.  T. 

A  Treatise  on  the  Diseases  of  Infancy  and  Childhood.  New  (sixth) 
edition,  thoroughly  revised  and  rewritten.  In  one  handsome  octavo  volume  of  867 
pages,  with  40  illustrations.     Cloth,  $4.50;  leather,  $5.50  ;  half  Russia,  $6.00.     Just  ready. 

but  one  book  on  the  diseases  of  children,  we 
would  unhesitatingly  say,  let  that  book  be  the  one 
which  is  the  subject  of  this  notice. — The  American 
Journal  of  the  Medical  Sciences,  April,  1886. 

No  better  work  on  children's  diseases  could  be 
placed  in  the  hands  of  the  student,  containing,  as 
it  does,  a  very  complete  account  of  the  symptoms 
and  pathology  of  the  diseases  of  early  life,  and 
possessing  the  further  advantage,  in  which  it 
stands  alone  amongst  other  works  on  its  subject, 
of  recommending  treatment  in  accordance  with 
the  most  recent  therapeutical  views. — British  and 
Foreign  Medico-Chirurgical  Review. 


Rarely  does  a  pleasanter  task  fall  to  the  lot  of 
the  bibliographer  than  to  announce  the  appearance 
of  a  new  edition  of  a  medical  classic  like  Prof.  J. 
Lewis  Smith's  Treatise  on  the  Diseases  of  Infancy 
and  Childhood.  For  years  it  has  stood  high  in  the 
confidence  of  the  profession,  and  with  the  addi- 
tions and  alterations  now  made  it  may  be  said  to 
be  the  best  book  in  the  language  on  the  subject  of 
which  it  treats.  An  examination  of  the  text  fully 
sustains  the  claims  made  in  the  preface,  that  "in 
preparing  the  sixth  edition  the  author  has  revised 
the  text  10  such  an  extent  that  a  considerable 
part  of  the  book  may  be  considered  new."  If  the 
young  practitioner  proposes  to  place  in  his  library 


KBATIWG,  JOHW  M.,  M,  D., 

Lecturer  on  the  Diseases  vf  Children  at  the  University  of  Pennsylvania,  etc. 

The  Mother's  Guide  in  the  Management  and  Feeding  of  Infants. 

one  handsome  12mo.  volume  of  118  pages.     Cloth,  $1.00. 


In 


Works  like  this  one  will  aid  the  physician  im- 
mensely, for  it  saves  the  time  he  is  constantly  giv- 
ing his  jaatients  in  instructing  them  on  the  sub- 
jects here  dwelt  upon  so  thoroughly  and  prac- 
tically. Dr.  Keating  has  written  a  practical  book, 
has  carefully  avoided  unnecessary  repetition,  and 


successfully  instructed  the  mother  in  such  details 
of  the  treatment  of  her  child  as  devolve  upon  her. 
He  has  studiously  omitted  giving  prescriptions, 
and  instructs  the  mother  when  to  call  upon  the 
doctor,  as  his  duties  are  totally  distinct  from  hers. 
— American  Journal  of  Obstetrics,  October,  1881. 


owuw,  EiyMuwiy,  m.  b.,  f.  m.  c,  s., 

Surgeon  to  the  Children's  Hospital,  Oreat  Ormond  St.,  London. 


Surgical  Diseases  of  Children. 

chromo-lithographic  plates  and  85  woodcuts. 
ical  Manuals,  page  4. 

One  is  immediately  struck  on  reading  this  book  | 
with  its  agreeable  style  and  the  evidence  it  every- 
where presents  of  the  practical  familiarity  of  its 
author   with    his    subject.      The    book    may    be  | 


In  one  12mo.  volume  of  525  pages,  with  4 
Just  ready.     Cloth,  $2.     See  Series  of  Clin- 

honestly  recommended  to  both  students  and 
practitioners.  It  is  full  of  sound  information, 
pleasantly  given. — Annals  of  Surgery,  May,  1886. 


WEST,  CHAMLES,  M.  D., 

Physician  to  the  Hospital  for  Sick  Children,  London,  etc. 

On  Some  Disorders  of  the  Nervous  System  in  Childhood. 

12mo.  volume  of  127  pages.     Cloth,  $1.00. 


In  one  small 


WEST'S  LECTURES  ON  THE  DISEASES  OF  IN- 
FANCY AND  CHILDHOOD.    In  one  octavo  vol. 
CONDIE'S     PRACTICAL    TREATISE    ON    THE 


DISEASES  OF  CHILDREN.  Sixth  edition,  re- 
vised and  augmented.  In  one  octavo  volume  of 
779  pages.    Cloth,  S5.25;  leather,  $6.26. j. 


Lea  Brothers  &  Co.'s  Publications — Med.  Juris.,  Miscel. 


31 


TIJDY,  CJEEABLBS  MBYMOTT,  M.  B,,  F.  C.  S., 

Professor  of  Chemistry  and  of  Forensic  Medicine  and  Public  Health  at  the  London  Hospital,  etc. 

Legal  Medicine.  Volume  II.  Legitimacy  and  Paternity,  Pregnancy,  Abor- 
tion, Rape,  Indecent  Exposure,  Sodomy,  Bestiality,  Live  Birth,  Infanticide,  Asphyxia, 
Drowning,  Hanging,  Strangulation,  Suffocation.  Making  a  very  handsome  imperial  oc- 
tavo volume  of  529  pages.     Cloth;  $6.00 ;  leather,  $7.00. 

Volume  I.  Containing  664  imperial  octavo  pages,  with  two  beautiful  colored 
plates.     Cloth,  $6.00 ;  leather,  $7.00. 


The  satisfaction  expressed  with  the  first  portion 
of  this  work  is  in  no  wise  lessened  by  a  perusal  of 
the  second  volume.  We  find  it  characterized  by 
the  same  fulness  of  detail  and  clearness  of  ex- 
pression which  we  had  occasion  so  highly  to  com- 
mend in  our  former  notice,  and  which  render  it  so 
valuable   to    the   medical   jurist.      The   copious 


tables  of  cases  appended  to  each  division  of  the 
subject,  must  have  cost  the  author  a  prodigious 
amount  of  labor  and  research,  but  they  constitute 
one  of  the  most  valuable  features  of  the  book, 
especially  for  reference  in  medico-legal  trials. — 
A7neriean  Journal  of  the  Medical  Sciences,  April,  1884. 


TAYLOM,  AJLFBJED  S,,  M,  D., 

Lecturer  on  Medical  Jurisprudence  and  Chemistry  in  Ouy^s  Hospital,  London. 

A  Manual  of  Medical  Jurisprudence.  Eighth  American  from  the  tenth  Lon- 
don edition,  thoroughly  revised  and  rewritten.  Edited  by  John  J.  Reese,  M.  D.,  Professor 
of  Medical  Jurisprudence  and  Toxicology  in  the  University  of  Pennsylvania.  In  one 
large  octavo  volume  of  937  pages,  with  70  illustrations.  Cloth,  $5.00 ;  leather,  $6.00 ;  half 
Russia,  raised  bands,  $6.50. 


The  American  editions  of  this  standard  manual 
have  for  a  long  time  laid  claim  to  the  attention  of 
the  profession  in  this  country;  and  the  eighth 
comes  before  us  as  embodying  the  latest  thoughts 
and  emendations  of  Dr.  Taylor  upon  the  subject 
to  which  he  devoted  his  life  with  an  assiduity  and 
success  which  made  him  facile  princeps  among 
English  writers  on  medical  jurisprudence.  Both 
the  author  and  the  book  have  made  a  mark  too 
deep  to  be  affected  by  criticism,  whether  it  be 
censure  or  praise.  In  this  case,  however,  we  should 


only  have  to  seek  for  laudatory  terms. — American 
Journal  of  the  Medical  Sciences,  Jan.  1881. 

This  celebrated  work  has  been  the  standard  au- 
thority in  its  department  for  thirty-seven  years, 
both  in  England  and  America,  in  both  the  profes- 
sions which  it  concerns,  and  it  is  improbable  that 
it  will  be  superseded  in  many  years.  The  work  is 
simply  indispensable  to  every  physician,  and  nearly 
so  to  every  liberally-educated  lawyer,  and  we 
heartily  commend  the  present  edition  to  both  pro- 
fessions.— Albany  Law  Journal,  March  26, 1881. 


By  the  Same  Author. 

The  Principles  and  Practice  of  Medical  Jurisprudence.  Third  edition. 
In  two  handsome  octavo  volumes,  containing  1416  pages,  with  188  illustrations.  Cloth,  $10 ; 
leather,  $12.     Just  ready. 


For  years  Dr.  Taylor  was  the  highest  authority 
in  England  upon  the  subject  to  which  he  gave 
especial  attention.  His  experience  was  vast,  his 
judgment  excellent,  and  his  skill  beyond  cavil.  It 
is  therefore  well  that  the  work  of  one  who,  as  Dr. 
Stevenson  says,  had  an  "enormous  grasp  of  all 


matters  connected  with  the  subject,"  should  be 
brought  up  to  the  present  day  and  continued  in 
its  authoritative  position.  To  accomplish  this  re- 
sult Dr.  Stevenson  has  subjected  it  to  most  careful 
editing,  bringing  it  well  up  to  the  times. — Aineri- 
can  Journal  (y  the  Medical  Sciences,  Jan.  1884. 


By  the  Same  Author. 

Poisons  in  Belation  to  Medical  Jurisprudence  and  Medicine.  Third 
American,  from  the  third  and  revised  English  edition.  In  one  large  octavo  volume  of  788 
pages.    Cloth,  $5.50 ;  leather,  $6.50. 

BJEBJPJEJR,  AUGUSTUS  J.,  M.  S,,  M.  B,,  F.  B.  C.  S., 

Examiner  in  Forensic  Medicine  at  the  University  of  London. 
Forensic  Medicine.    In  one  pocket-size  12mo.  volume.    Preparing.    See  Students'' 
Series  of  Manuals,  page  4. 

LEA,  JEEENBY  C, 

Superstition  and  Force :  Essays  on  The  Wager  of  Law,  The  Wager  of 
Battle,  The  Ordeal  and  Torture.  Third  revised  and  enlarged  edition.  In  one 
handsome  royal  12mo.  volume  of  552  pages.     Cloth,  $2.50. 


This  valuable  work  is  in  reality  a  history  of  civ- 
ilization as  interpreted  by  the  progress  of  jurispru- 
dence. .  .  In  "  Superstition  and  Force  "  we  have  a 
philosophic  survey  of  the  long  period  intervening 
between  primitive  barbarity  and  civilized  enligh^ 
enment.    There  is  not  a  chapter  in  the  work  that 


should  not  be  most  carefully  studied ;  and  however 
well  versed  the  reader  may  be  in  the  science  of 
jurisprudence,  he  will  find  much  in  Mr.  Lea's  vol- 
ume of  which  he  was  previously  ignorant.  The 
book  is  a  valuable  addition  to  the  literature  of  so- 
cial science. —  Westm,inster  Review,  Jan.  1880. 


By  the  Same  Author. 
Studies  in  Church  History.    The  Rise  of  the  Temporal  Power — Ben- 


efit of  Clergy — Excommunication 

octavo  volume  of  605  pages.     Cloth,  $2.50. 

The  author  is  pre-eminently  a  scholar.  He  takes 
up  every  topic  allied  with  the  leading  theme,  and 
traces  it  out  to  the  minutest  detail  with  a  wealth 
of  knowledge  and  impartiality  of  treatment  that 
compel  admiration.  The  amount  of  information 
compressed  into  the  book  is  extraordinary.  In  no 
other  single  volume  is  the  development  of  the 


New  edition.     In  one  very  handsome  royal 

Just  ready. 

primitive  church  traced  with  so  much  clearness, 
and  with  so  definite  a  perception  of  complex  or 
conflicting  sources.  The  fifty  pages  on  the  growth 
of  the  papacy,  for  instance,  are  admirable  for  con- 
ciseness and  freedom  from  prejudice. — Boston 
Traveller,  May  3, 1883. 


Allen's  Anatomy  .... 

American  Journal  of  the  Medical  Sciences 

American  System  of  Gynaecology    . 

American  System  of  Practical  Medicine  . 

An  American  System  of  Dentistry 

Anderson  on  the  Skin 

*Ashhurst's  Surgery     .... 

Ashwell  on  Diseases  of  Women 

Attfield's  Chemistry      .... 

Ball  on  the  Rectum  and  Anus 

Barker's  Obstetrical  and  Clinical  Bssays, 

Barlow's  Practice  of  Medicine 

Barnes'  Midwifery         .... 

*Barnes  on  Diseases  of  Women 

Barnes'  System  of  Obstetric  Medicine 

Bartholow  on  Electricity 

Basham  on  Renal  Diseases    . 

Bell's  Comparative  Physiology  and  Anatomy 

Bellamy's  Operative  Surgery 

Bellamy's  Surgical  Anatomy 

Blandford  on  Insanity 

Bloxam's  Chemistry      .... 

*Bristowe's  Practice  of  Medicine    . 

Broadbent  on  the  Pulse 

Browne  on  the  Ophthalmoscope     . 

Browne  on  the  Throat 

Bruce's  Materia  Medica  and  Therapeutics 

Brunton's  Materia  Medica  and  Therapeutics 

Bryant  on  the  Breast    .... 

*Bryant's  Practice  of  Surgery 

*Bumstead  on  Venereal  Diseases    . 

♦Burnett  on  the  Ear       .... 

Butlin  on  the  Tongue    .... 

Carpenter  on  the  Use  and  Abuse  of  Alcohol 

•Carpenter's  Human  Physiology    . 

Carter  &  Frost's  Ophthalmic  Surgery 

Century  of  American  Medicine 

Chambers  on  Diet  and  Regimen 

Charles'  Physiological  and  Pathological  Chem, 

Churchill  on  Puerperal  Fever 

Clarke  and  Lockwood's  Dissectors'  Manual 

Classen's  Quantitative  Analysis 

Cleland's  Dissector        .... 

Clouston  on  Insanity    .... 

Clowes'  Practical  Chemistry 

Coats'  Pathology  .... 

Cohen  on  the  "Throat     .... 

Coleman's  Dental  Surgery 

Condie  on  Diseases  of  Children 

Cornil  on  Syphilis 

'i'Cornil  and  Ranvier's  Pathological  Histology 

Cullerier's  Atlas  of  Venereal  Diseases 

Curnow's  Medical  Anatomy 

Dalton  on  the  Circulation 

♦Dalton's  HumanPhysiology 

Davis'  Clinical  Lectures 

Draper's  Medical  Physics 

Druitt's  Modern  Surgery 

Duncan  on  Diseases  of  Women 

*Dunglison's  Medical  Dictionary    . 

Edes'  Materia  Medica  and  'Therapeutics 

Edis  on  Diseases  of  Women   . 

Ellis' Demonstrations  of  Anatomy 

Emmet's  Gynaecology 

*Erichsen's  System  of  Surgery 

Esmarch's  Early  Aid  in  Injuries  and  Accid'ts 

Farquharson's  Therapeutics  and  Mat.  Med. 

Fenwick's  Medical  Diagnosis 

Finlayson's  Clinical  Diagnosis 

Flint  on  Auscultation  and  Percussion 

Flint  on  Phthisis  .... 

Elint  on  Physical  Exploration  of  the  liUngs 

Flint  on  Respiratory  Organs 

Flint  on  the  Heart         .... 

Flint's  Essays       ... 

*Flint's  Practice  of  Medicine 

Folsom's  Laws  of  TJ.  S.  on  Custody  of  Insane 

Foster's  Physiology'       .... 

•"Fothergilrs  Handbook  of  Treatment     . 

Fownes'  Elementary  Chemistry 

Fox  on  Diseases  of  the  Skin  . 

Frankland  and  Japp's  Inorganic  Chemistry 

Fuller  on  the  Lungs  and  Air  Passages     . 

Galloway's  Analysis     .... 

Gibney's  Orthopsedic  Surgery 

<3ould's  Surgical  Diagnosis     . 

*Gray's  Anatomy  ..... 

Greene's  Medical  Chemistry  . 

Green's  Pathology  and  Morbid  Anatomy 

Griffith's  Universal  Formulary 

Gross  on  Foreign  Bodies  in  Air- Passages 

Gross  on  Impotence  and  Sterility    . 

Gross  on  Urinary  Organs 

*Gross'  System  of  Surgery 

Habershon  on  the  Abdomen 

'*Hamilton  on  Fractures  and  Dislocations 

Hamilton  on  Nervous  Diseases 

Hartshorne's  Anatomy  and  Physiology  . 

Hartshorne's  Conspectus  of  the  Med.  Sciences 

Hartshorne's  Essentials  of  Medicine 

Hartshorne's  Household  Medicine 

Hermann's  Experimental  Pharmacology 

Hill  on  Syphilis  ..... 

Hillier's  Handbook  of  Skin  Diseases 

Hoblyn'a  Medical  Dictionary 

Hodge  on  Women         .... 

Hodge's  Obstetrics        .... 

Hoffmann  and  Power's  Chemical  Analysis 

Holden's  Landmarks    .... 

Holland's  Medical  Notes  and  Reflections 


4,21 
29 
17 
29 
27 
29 
17 
24 

4,   7 

4,20 
6 
19 
9 
14 

4,16 
23 
18 
11 
11 

4,21 
21 
25 
23 

4,21 


4,23 
14 
17 
10 
28 
4,6 
10 

5 
19 
10 
13 
18 
24 
30 
25 
13 
25 
4,  6 

7 

8 
17 

7 
20 
28 

4 
12 
27 

7 
28 
21 
24 
12 
16 
16 
18 
18 
18 
18 
18 
18 
14 
19 


26 

9 

18 

8 

20 

4,20 

5 

10 

13 

11 

18 

25 

25 

20 

le 

22 
19 

6 

3 
14 
17 
11 
25 
26 

4 

28 
28 
10 

5 
17 


♦Holmes'  System  of  Surgery 

Horner's  Anatomy  and  Histology  . 

Hudson  on  Fever 

Hutchinson  on  Syphilis 

Hyde  on  the  Diseases  of  the  Skin    . 

Jones  (C.  Handfield)  on  Nervous  Disorders 

Juler's  Ophthalmic  Science  and  Practice 

Keating  on  Infants       .... 

King's  Manual  of  Obstetrics  . 

Klein's  Histology  .... 

Landis  on  Labor  .... 

La  Roche  on  Pneumonia,  Malaria,  etc.     . 

La  Roche  "on  Yellow  Fever    . 

Laurence  and  Moon's  Ophthalmic  Surgery 

Lawson  on  the  Eye,  Orbit  and  Eyelid 

Lea's  Studies  in  Church  History 

Lea's  Superstition  and  Force 

Lee  on  Syphilis 

Lelimann  s  Chemical  Physiology    . 

*Leishman's  Midwifery 

Lucas  on  Diseases  of  the  Urethra   . 

Ludlow's  Manual  of  Examinations 

Lyons  on  Fever  ..... 

Maisch's  Organic  Materia  Medica  . 

Marsh  on  the  Joints 

May  on  Diseases  of  Women  . 

Medical  News 

Medical  News  Visiting  List  . 

Medical  News  Physicians'  Ledger  . 

Meigs  on  Childbed  Fever 

Miller's  Practice  of  Surgery   . 

Miller's  Principles  of  Surgery 

Mitchell's  Nervous  Diseases  of  Women   . 

Morris  on  Diseases  of  the  Kidney  . 

Morris  on  Skin  Diseases 

Neill  and  Smith's  Compendium  of  Med.  Scl. 

Nettleship  on  Diseases  of  the  Eye  . 

Norris  and  Oliver  on  the  Eye 

Owen  on  Diseases  of  Children 

*Parrish's  Practical  Pharmacy 

Parry  on  Extra-Uterine  Pregnancy 

Parvin's  Midwifery         .... 

Pavy  on  Digestion  and  its  Disorders 

Pepper's  System  of  Medicine 

Pepper's  Forensic  Medicine   ... 

Pepper's  Surgical  Pathology 

Pick  on  Fractures  and  Dislocations 

Pirrie's  System  of  Surgery    . 

Playfair  on  Nerve  Prostration  and  Hysteria 

*Playtair's  Midwifery  . 

Politzer  on  the  Ear  and  its  Diseases 

Power's  Human  Physiology  ... 

Purdy  on  Bright's  Disease  and  Allied  A  fifections 

Ralfe's  Clinical  Chemistry 

Ramsbotham  on  Parturition 

Bemsen's  Theoretical  Chemistry    . 

♦Reynolds' System  of  Medicine 

Richardson's  Preventive  Medicine 

Roberts  on  Urinary  Diseases 

Roberts'  Compend  of  Anatomy 

Roberts'  Principles  and  Practice  of  Surgery 

Robertson's  Physiological  Physics 

Ross  on  Nervous  Diseases 

Savage  on  Insanity,  including  Hysteria  . 

Schafer's  Essentials  of  Histology, 

Schreiber  on  Massage   . 

Seller  on  the  Throat,  Nose  and  Naso-Pharynx 

Series  of  Clinical  Manuals 

Simon's  Manual  of  Chemistry 

Skey's  Operative  Surgery 

Slade  on  Diphtheria 

Smith  (Edward)  on  Consumption 

*Smith  (J.  Lewis)  on  Children 

Smith's  Operative  Surgery     . 

Stllle  on  Cholera 

*Still6  &  Maisch's  National  Dispensatory 

*Still6's  Therapeutics  and  Materia  Medica 

Stimson  on  Fractures   .... 

Stimson's  Operative  Surgery 

Stokes  on  Fever  ..... 

Students' Series  of  Manuals  . 

Sturges'  Clinical  Medicine 

Tanner  on  Signs  and  Diseases  of  Pregnancy 

Tanner's  Manual  of  Clinical  Medicine     . 

Taylor  on  Poisons         .... 

♦Taylor's  Medical  Jurisprudence    . 

Taylor's  Prin.  and  Prac.  of  Med.  Jurisprudence 

♦Thomas  on  Diseases  of  Women 

Thompson  on  Stricture 

Thompson  on  Urinary  Organs 

Tidy's  Legal  Medicine .... 

Todd  on  Acute  Diseases 

Treves'  Manual  of  Surgery    . 

Treves'  Surgical  Applied  Anatom.y 

Treves  on  Intestinal  Obstruction    . 

Tuke  on  the  Influence  of  Mind  on  the  Body 

Visiting  List,  The  Medical  News     . 

Walshe  on  the  Heart    .... 

Watson's  Practice  of  Physic  . 

♦Wells  on  the  Eye         .... 

West  on  Diseases  of  Childhood        .      fc  . 

West  on  Diseases  of  Women  .      *. 

W^est  on  Nervous  Disorders  in  Childhood 

Williams  on  Consumption     . 

Wilson's  Handbook  of  Cutaneous  Medicine 

Wilson's  Human  Anatomy   . 

Winckel  on  Pathol,  and  Treatment  of  Childbed 

Wohler's  Organic  Chemistry 

Woodhead's  Practical  Pathology    . 

Year-Books  ol  Treatment  for  1884  and  1885 


Books  marked  *  are  also  bound  in  half  Russia. 


liEA   BROTHERS   &   CO.,    Philaclelpliia. 


